Cancer Treatment Today

Neaodjuvant chemotherapy (NAC) for gastric cancers, as presented in a recent metanalysis by Shumacher et al 2 , can slightly improve the survival rate [OR = 1.32, 95% confidence interval (CI): 1.07-1.64, P = 0.01], little, or no significant benefits were suggested in subgroup analyses between different population and regimens either. It can significantly improved the 3-year progression-free survival (PFS) [OR: 1.85 (1.39, 2.46), p<.0001], tumor down-staging rate [OR: 1.71 (1.26, 2.33), p = .0006]and R0 resection rate [OR: 1.38 (1.08, 1.78) p = .01]of patients with AGC. There were no difference between the two arms, in terms of relapse rates [OR: 1.03 (0.60, 1.78), p = 0.92], operative complications [OR: 1.20 (0.90, 1.58), p = 0.21], perioperative mortality [OR: 1.14 (0.64, 2.05), p = 0.65], andgrade 3/4 adverse effects. NAC can significantly down-stage the tumor and improve R0 resection rate of patients with gastric and gastroesophageal cancer. It is safe and feasible, and can be tolerated.

NCCN recommends several regimens as Category 1 evidence but does not prescribe a specific duration. 1. It says that other then category 1 recommendations can be modified based on clinical information.

1.NCCN, Esophageal Cancer ESOPH-f, 1

2. Schuhmacher C, Gretschel S, Lordick F, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 2010; 28:5210.