Neoadjuvant or adjuvant therapy for gastric cancer

Table 1 Neoadjuvant chemotherapy in gastric carcinoma: Randomized meta-analysis

Studies	Country	Years	Randomization arms	Surgery	Protocol	Patients (n)	Overall survival	P value	Disease free survival	P value
Neoadjuvant chemotherapy
Xiong et al[16] meta-analysis	-	2014	Chemotherapy	-	-	753	46.6% at 53 mo1	0.01	41.1% at 3 yr1	< 0.0001
			Surgery alone		-	813	43.7% at 53 mo		27.5% at 3 yr

¹Statistically significant result.

Table 2 Perioperative chemotherapy in gastric carcinoma: Randomized trials

Studies	Country	Years	Randomization arms	Surgery	Protocol	Patients (n)	Overall survival	P value	Disease free survival	P value
MRC MAGIC trial[17]	United Kingdom	2006	Chemotherapy and surgery	42.5% D2 surgery	ECF chemotherapy	250	36.3% at 5 yr1	0.009	34.8% at 5 yr1	< 0.001
			Surgery alone			253	23% at 5 yr		24.9% at 5 yr
ACCORD07/FFCD 9703 trial[18]	France	2011	Chemotherapy and surgery	D2 recommended	5FU-CDDP chemotherapy	113	38% at 5 yr1	0.02	34% at 5 yr1	0.003
			Surgery alone			111	24% at 5 yr		19% at 5 yr

¹Statistically significant result. ECF: Epirubicin, cisplatin, and 5-fluorouracil; 5FU: 5-fluorouracil; RT: Radiotherapy; CDDP: Cisplatin.

Table 3 Adjuvant chemotherapy in gastric carcinoma: Randomized trials/meta-analysis

Studies	Country	Years	Randomization arms	Surgery	Protocol	Patients (n)	Overall survival	P value	Disease free survival	P value
ACTS-GC trial[25,26]	Japan	2007	Chemotherapy and surgery	D2 surgery	Oral S1 chemotherapy	529	71.7% at 5 yr1	-	65.4% at 5 yr1	-
			Surgery alone			530	61.1% at 5 yr		53.1% at 5 yr
GASTRIC metaanalysis[24]	-	2010	Chemotherapy	-	-	1924	55.3% at 5 yr1	< 0.001	54% at 5 yr1	< 0.001
			Surgery alone		-	1857	49.6% at 5 yr		48.7% at 5 yr
CLASSIC trial[27]	South Korea	2012	Chemotherapy and surgery	D2 surgery	XELOX chemotherapy	520	83% at 3 yr1	0.049	74% at 3 yr1	< 0.0001
			Surgery alone			515	78% at 3 yr		59% at 3 yr

¹Statistically significant result. XELOX: Xeloda and oxaliplatin.

Table 4 Adjuvant chemoradiotherapy in gastric carcinoma: Randomized trials

Studies	Country	Years	Randomization arms	Surgery	Protocol	Patients (n)	Overall survival	P value	Disease free survival	P value
INT 0116 trial[28,29]	United States	2001	Chemoradiotherapy and surgery	10% D2 surgery	5FU Mayo clinic/5FU RT	281	50% at 3 yr1	0.005	48% at 3 yr1	< 0.001
			Surgery alone			275	41% at 3 yr		31% at 3 yr
Chinese multicentre trial[33]	China	2012	Chemoradiotherapy and surgery	D2 surgery	5FU RT	186	48.4% at 5 yr	0.122	45.2% at 5 yr1	0.029
			Chemotherapy and surgery		5FU chemotherapy	165	41.8% at 5 yr		35.8% at 5 yr
ARTIST trial[31]	South Korea	2012	Chemoradiotherapy and surgery	D2 surgery	Xeloda CDDP/Xeloda RT	230	-	-	74.2% at 3 yr	0.086
			Chemotherapy and surgery		Xeloda CDDP	228	-		78.2% at 3 yr
CALGB 80101 trial[30]	United States	2011	Chemoradiotherapy and surgery	Not available	ECF/5FU RT	266	52% at 3 yr	0.8	47% at 3 yr	0.99
			Chemoradiotherapy and surgery		5FU Mayo/5FU RT	280	50% at 3 yr		46% at 3 yr

¹Statistically significant result. 5FU: 5-fluorouracil; RT: Radiotherapy; CDDP: Cisplatin.

Table 5 Ongoing phase-III randomized trials

Study	Country	No. registration	Standard arm	Experimental arm	Patients (n)
Neoadjuvant chemoradiotherapy
EORTC 22114 - 40111 TOP GEAR study	Europe	NCT01924819	ECC/ECF preoperative CT	ECC/ECF preoperative CT and RTCT preoperative	752
Perioperative chemotherapy
MAGIC-B/ST03 study	United Kingdom	NCT00450203	ECC perioperative CT	ECC + bevacizumab perioperative CT	1100
PRODIGY trial	South Korea	NCT01515748	S-1 adjuvant CT	Neoadjuvant DOS CT and S-1 postoperative CT	640
Adjuvant chemotherapy
ARTIST II Trial	South Korea	NCT01761461	S-1 adjuvant CT (arm 1)	SOX adjuvant CT (arm 2), S-1 and RT adjuvant (arm 3)	1000
Adjuvant chemoradiotherapy
CRITICS Trial	The Netherlands	NCT00407186	ECC perioperative CT	ECC preoperative CT and RTCT postoperative	788

CT: Chemotherapy; RTCT: Radiochemotherapy; ECC: Epirubicin, cisplatin and capecitabine; ECF: Epirubicin, cisplatin, and fluorouracil; DOS: Docetaxel, oxaliplatin, and S-1; SOX: S-1 and oxaliplatin.