Optimal Chemoradiotherapy Regimen After Curative Resection of Gastric Cancer

10/12/17

A recent study compared the effects of multiple adjuvant chemoradiotherapy regimens on overall survival (OS) in patients with gastric or gastroesophageal junction adenocarcinoma, published in the Journal of Clinical Oncology (online October 4, 2017; doi:10.1200/JCO.2017.74.2130).

A previous phase III trial (Intergroup Trial 0116) demonstrated superior survival in patients with curative resection for gastric cancer after postoperative chemoradiotherapy involving bolus fluorouracil and leucovorin, compared with surgery alone. However, further trials are needed to assess whether more active regimens could replace bolus fluorouracil plus leucovorin as the optimal therapy option for improving OS.

Charles S Fuchs, MD, MPH, Yale School of Medicine, and colleagues conducted a phase III study (CALGB 80101) to assess whether a potentially more active systemic therapy regimen could replace the previously established regimen and further improve overall survival in patients with resected gastric or gastroesophageal junction adenocarcinoma. A total of 546 patients were recruited who had undergone curative resection of stage IB through IV disease between 2002 and 2009. Patients were randomly assigned to receive either postoperative bolus fluorouracil plus leucovorin before and after combined bolus fluorouracil and radiotherapy (FU plus LV arm) or postoperative epirubicin, cisplatin, and infused bolus fluorouracil before and after combined bolus fluorouracil and radiotherapy (ECF arm).

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After a median follow-up of 6.5 years, researchers reported that the 5-year overall survival rates were 44% in the FU plus LV arm and 44% in the ECF arm. Similarly, 5-year disease-free survival rates were comparable between the treatment arms (39% in the FU plus LV arm vs 37% in the ECF arm).

Post hoc analyses demonstrated that the effect of treatment seemed to be similar across all of the examined patient subgroups.

After reviewing the findings from the trial, researchers concluded that postoperative chemoradiotherapy using a multi-agent regimen before and after radiotherapy does not improve survival compared with bolus fluorouracil plus leucovorin before and after radiotherapy in patients who have undergone curative resection for gastric or gastroesophageal junction adenocarcinoma.—Zachary Bessette