This document discusses several studies on neoadjuvant chemotherapy for gastric cancer. It summarizes the MAGIC trial which found that platinum-based neoadjuvant chemotherapy improved 5-year survival by 6% compared to surgery alone. It also discusses the ACCORD 07 trial which found that neoadjuvant chemotherapy led to higher R0 resection rates and improved disease-free survival compared to surgery alone. Finally, it summarizes the STOPEROPCHEM trial comparing neoadjuvant chemotherapy followed by surgery to surgery alone for resectable gastric cancer. The document concludes that a multidisciplinary team approach is positive and perioperative chemotherapy can induce downstaging, increase R0 resection rates, and improve disease-free and overall survival

1. NEOADJUVANT GASTRIC CANCER
MR4 VICTOR PAITAN AMARO
MEDICINA ONCOLOGICA
INEN

4. 5y survival rate increased by 6%
Platinum regimens??

7. MAGIC TRIAL
74% stomach
41.6% completed treatment
40.4 vs 42,5% D2

9. ACCORD 7 TRIAL
Eligibility:
- Adenocarcinoma
- Lower third esophagus or GEJ
or stomach.
- Resectable
- PS 0-1
Primary:
- OS
- Secondary:
- DFS, R0 resection rate, Safety
Chemo:
- 2 or 3 cycles pre
- FU 800 mg/m2/d continuous IV
for 5 days (1-5)
- Cisplatin 100 mg/m2 day 1
- Each 28 days
- 3 to 4 cycles post
4 -6 w
4 w
25% stomach
D2??
J Clin Oncol 29: 1715–1721. 2011

10. R0 84 vs 74%
v
v
v
DFS 34 vs 19% HR: 0.65 CI: 0.48-0.89 p=0.003

12. Cochrane Database Syst Rev 5: CD008107. 2013
v
v

13. Cochrane Database Syst Rev 5: CD008107. 2013
v

14. STOPEROPCHEM TRIAL
Eligibility:
- Histopathologically gastric
cancer
- Resectable cT2-4a N0-3 M0
- PS 0-1
Primary:
- cancer free and overall survival
- Secondary:
- Overall and severe toxicity rate
- Chemo related mortality
- rate dose reduction of chemo
- rate of chemo cessation
Chemo:
- 2 or 3 cycles pre
- EOX: epirrubicin 50mg/m2 D1,
oxaliplatin 130mg/m2 D1,
capecitabine 625mg/m2/12h
D1-21 each 3 weeks
Arm experimental:
PreOperative: EOX 3weeks -
surgery D2 - Postoperative
EOX 3 weeks
Arm no intervention:
PreOperative: EOX 3weeks -
surgery D2 -

17. v

18. CONCLUSIONS
• Multidisciplinary team approach
• Positive: Perioperative: induces downstaging, increase
R0 resection, improves DFS and OS, better compliance
• Negative: Further research pre vs post, tumor site.