Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7343-7348
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7343
Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond
Audrey H Choi, Joseph Kim, Joseph Chao
Audrey H Choi, Joseph Kim, Department of Surgical Oncology, City of Hope, Duarte, CA 91010, United States
Joseph Chao, Department of Medical Oncology, City of Hope, Duarte, CA 91010, United States
Author contributions: All authors contributed to the manuscript.
Supported by National Cancer Institute of the National Institutes of Health under award, No. NIH 5K12CA001727-20.
Conflict-of-interest: The authors do not have any relevant disclosures.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joseph Chao, MD, Department of Medical Oncology, City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, United States. jchao@coh.org
Telephone: +1-626-2189200 Fax: +1-626-3018233
Received: January 29, 2015
Peer-review started: January 30, 2015
First decision: March 10, 2015
Revised: March 26, 2015
Accepted: May 2, 2015
Article in press: May 4, 2015
Published online: June 28, 2015
Processing time: 152 Days and 13.2 Hours
Abstract

Over the last 15 years, there have been major advances in the multimodal treatment of gastric cancer, in large part due to several phase III studies showing the treatment benefits of neoadjuvant and adjuvant chemotherapy and chemoradiation protocols. The objective of this editorial is to review the current high-level evidence supporting the use of chemotherapy, chemoradiation and anti-HER2 agents in both the neoadjuvant and adjuvant settings, as well as to provide a clinical framework for use of this data based on our own institutional protocol for gastric cancer. Major studies reviewed include the SWOG/INT 0116, Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC), CLASSIC, ACTS-GC, Adjuvant Chemoradiation Therapy in Stomach Cancer (ARTIST) and Trastuzumab for Gastric Cancer trials. Although these studies have demonstrated that multiple approaches in terms of the timing and therapy for gastric cancer are effective, no standard of care is widely accepted and questions regarding the optimal timing of chemotherapy, the benefit of radiotherapy, the minimum required extent of lymphadenectomy and optimal chemotherapy regimen still exist. Protocols from the upcoming ARTIST II, CRITICS, TOPGEAR, Neo-AEGIS and MAGIC-B studies are outlined, and results from these studies will provide critical information regarding optimal timing and treatment regimen. Additionally, the future directions of gastric cancer research predicated on molecular profiling and tailored therapies based on targetable genetic alterations in individual patient’s tumors are addressed.

Keywords: Gastric cancer; Neoadjuvant therapy; Adjuvant therapy; Chemotherapy; Chemoradiation

Core tip: Although multiple phase III trials have been performed around the world, no standard of care exists for the treatment of gastric cancer. We reviewed the existing high-level evidence supporting the use of neoadjuvant and adjuvant chemotherapy, chemoradiation, and anti-HER2 therapies in gastric cancer, as well as provide a clinical framework for the treatment of gastric cancer patients at our institution based on these studies. Also highlighted in this editorial are current clinical trials in progress and future directions of gastric cancer research based on next generation sequencing data.