ASO Author Reflections: Future Prospects of Neoadjuvant Chemotherapy for Gastric Cancer
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Future Prospects of Neoadjuvant Chemotherapy for Gastric Cancer Masayuki Kano, MD, PhD, and Hisahiro Matsubara, MD, PhD Department of Frontier Surgery, Chiba University, Chiba, Japan
PAST Gastrectomy with D2 lymphadenectomy with or without adjuvant chemotherapy for locally advanced gastric cancer is a standard treatment strategy in eastern Asia. However, patients’ prognosis of novel therapeutic strategy for locally advanced gastric cancer have been shown to have further reformability than standard D2 gastrectomy and adjuvant chemotherapy. In Japan, postoperative S-1 monotherapy for 1 year or capecitabine plus oxaliplatin for 6 months have been recognized for national insurance as standard therapy, and the selection of these two regimens for postoperative therapy is entrusted for the physicians. It has been widely considered that neoadjuvant chemotherapy (NAC) has several advantages over adjuvant settings in Japan. However, NAC has very limited evidence in Japan.1 PRESENT S-1 plus cisplatin (SC) is a standard treatment for metastatic gastric cancer in eastern Asia. Promising survival results of NAC SC have been reported from a small phase II trial evaluating two courses of NAC SC for bulky nodal disease.1 However, NAC SC phase III trials for large type 3 or 4 gastric cancer have not shown favorable results for NAC for advanced resectable gastric cancer.2
ASO Author Reflections is a brief invited commentary on the article, ‘‘Survival Benefit of Neoadjuvant Chemotherapy with S-1 Plus Docetaxel for Locally Advanced Gastric Cancer: A Propensity ScoreMatched Analysis,’’ Ann Surg Oncol. 2019;26:1805–13. Ó Society of Surgical Oncology 2019 First Received: 5 September 2019 M. Kano, MD, PhD e-mail: [email protected]
S-1 plus docetaxel (DS) is thought to be an alternative regimen when standard SC regimen cannot be used for metastatic gastric cancer in Japan. However, the effectiveness of DS adjuvant chemotherapy for pStage III gastric cancer was recently reported (JACCRO GC-07) at the 2018 American Society of Clinical Oncology Annual Meeting.3 Postoperative DS regimen for pStage III gastric cancer will be scheduled for the standard treatment in Japan. Our study showed that the 3-year PFS rates in the NAC DS group for cStage IIB and III gastric cancer patients were higher than those in the surgery-first group.4 FUTURE The present results of our study suggest that NAC DS chemotherapy should be considered for the test arm of an RCT compared with the standard treatment. An international study with standardized D2 dissection may lead to more valuable research results. Whether doublet or triplet regimens should be used for neoadjuvant chemotherapy is controversial. Satisfactory three-year overall survival rates of perioperative triplet regimens in a phase II trial have been reported. Reports on perioperative chemotherapy using triplet agents have shown a high rate of grade 3/4 adverse events. Furthermore, DCS phase III trials for metastatic gastric cancer (JCOG1013) have not shown f
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