General Session 2: Perioperative Therapies for Gastric Cancer

Trevor Leong, MBBS, MD, FRANZCR
Peter MacCallum Cancer Centre
Neoadjuvant Strategies and Indications

Conclusions:

Preoperative therapy better tolerated than  postoperative therapy

Preoperative therapy allows tumor downstaging

Preoperative (perioperative) chemotherapy is a standard of care in Western countries

Preoperative chemoradiation for gastric cancer is safe, feasible and has an acceptable toxicity profile

Preoperative chemoradiation does not increase surgical morbidity

Gastric irradiation is complex and requires strict QA

Phase III Preoperative chemoradiation trials are ongoing



David Cunningham, MD
The Royal Marsden NHS Foundation Trust, Sutton and London Hospital
Optimizing Adjuvant Therapy

Summary:

Adjuvant chemotherapy improves survival in gastric cancer

Adjuvant CRT benefits patients with limited node dissection

Patients with MSI-H tumors have a better prognosis and do not appear to benefit from adjuvant chemotherapy

Gene expression and radiomic signatures provide valuable prognostic and predictive information



Shaila Merchant, MD, MSc, MHSc, FRCSC, FACS
Queen's University
Disparities in Management of Esophago-Gastric Cancers

Key Points:

Disparities in survival are large, multi-factorial and linked

Need to aim beyond describing disparities, try to narrow the gap

Need buy-in from clinicians, policymakers, government

Limitation of the literature

- retrospective

- individual factor contributions unclear

Marcia Cruz-Correa, MD, PhD
The University of Puerto Rico and MD Anderson Cancer Center
Current and Upcoming Clinical Trials

Reported two trials:

Study Title: Adjuvant Immunotherapy in Patients With Resected Gastric Cancer Following Preoperative Chemotherapy With High Risk for Recurrence (N+ and/or R1): an Open Label Randomized Controlled Phase-2-study

ClinicalTrials.gov Identifier: 03443856 Opening soon

Study Title: A Multicenter, Double-blind, Randomized Study in Patients With Gastric Cancer Undergoing Postoperative Adjuvant Chemotherapy

ClinicalTrials.gov Identifier: 03006705 currently accruing

Study Title: Prospective Multicenter Phase III Trial Using CRS With / Without HIPEC After Preoperative Chemotherapy in Patients With Peritoneal Carcinomatosis of Gastric Cancer Incl. Adenocarcinoma of the Esophagogastric Junction

ClinicalTrials.gov Identifier: 02158988 Recruiting

Study Title: Targeted Chemoprevention of Gastric Carcinogenesis in High Risk Populations

ClinicalTrials.gov Identifier: 02794428 Currently Recruiting