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World J Gastroenterol. Sep 7, 2014; 20(33): 11567-11573
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11567
What make differences in the outcome of adjuvant treatments for resected gastric cancer?
Toshifusa Nakajima, Masashi Fujii
Toshifusa Nakajima, Department of Gastrointestinal Surgery, Cancer Institute Ariake Hospital, Tokyo 135-8550, Japan
Toshifusa Nakajima, The vice president, Japan Cancer Clinical Research Organization (JACCRO) Chuo-ku, Tokyo 104-0061, Japan
Masashi Fujii, Department of Surgery, Nihon University Surugadai Hospital, Tokyo 101-0062, Japan
Author contributions: Nakajima T and Fujii M performed research, and Nakajima T wrote the paper.
Correspondence to: Toshifusa Nakajima, MD, PhD, Department of Gastrointestinal Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research. 3-10-6, Ariake, Koto-ku, Tokyo 135-8550, Japan. nakajima@jfcr.or.jp
Telephone: +81-3-35200111 Fax: +81-3-35700343
Received: October 23, 2013
Revised: November 26, 2013
Accepted: April 8, 2014
Published online: September 7, 2014
Processing time: 318 Days and 22.4 Hours
Abstract

After a long history of Dark Age of adjuvant chemotherapy for gastric cancer, definite evidences of survival benefit from adjuvant treatment have been reported since 2000s. These survival benefits are likely attributed to something new approach different from pervious studies. In 2001, South West Oncology Group INT0116 trial yielded survival benefit in curatively resected gastric cancer patients with postoperative chemoradiotherapy [5-fluorouracil (5-FU) + Leucovorin + radiotherapy], followed by positive result by MAGIC Trial, employing peri-operative(pre- and postoperative chemotherapy with Epirubicin, cisplatin (CDDP), 5-fluorouracil (ECF) regimen in patients with curative resection. A novel drug [S1: ACTS-GC (Adjuvant chemotherapy trial of TS-1 for gastric cancer) in 2007], or new drug combination chemotherapys [CDDP + 5-FU: FNCLCC/FFCD (Federation Nationale des Centres de Lutte contre le cancer/Federation Francophone de Cancerologie Digestive) in 2011, Capecitabine + Oxaliplatin: CLASSIC in 2012] also produced positive results in terms of improved prognosis. Neoadjuvant or perioperative chemotherapy, novel anti-cancer drugs, and chemoradiotherapy might be the key words to develop further improvement in the adjuvant treatment of resectable gastric cancer. Moreover, it is not new but still true to stress the importance of D2 surgery as the baseline treatment in order to minimize the amount of residual tumor after surgery.

Keywords: Resected gastric cancer; Phase III clinical trial; Adjuvant and neo-adjuvant therapy; Chemoradiotherapy; Review

Core tip: Recent positive results of adjuvant clinical trials for gastric cancer are attributed to new approaches different from previous negative trials. Inclusion of novel effective drug (S-1: ACTS-GC) and new combination of drugs (capecitabine and oxaliplatin: CLASSIC/Cisplatin and 5-fluorouracil: FNCLCC/FFCD), combination of chemotherapy and radiotherapy (SWOG INT0116), and combination of different timing (pre- and postoperative: MAGICC), might have contributed to yield positive results after curative D2 surgery. D2 surgery is going to be adopted as recommended treatment in Eastern and Western countries, and should be the baseline treatment to minimize the amount of residual tumor in future trials of adjuvant treatment.