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19.07.2022 | short review

Neoadjuvant treatment in gastric cancer

verfasst von: Bettina Sonnweber, Marc Schaber, MD Ewald Wöll

Erschienen in: memo - Magazine of European Medical Oncology

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Summary

Despite recent advances in the treatment of gastric cancer, mortality related to this disease is still substantial. Surgery and chemotherapy represent the cornerstones of patient management. Targeted treatments that include anti-angiogenic agents and the advent of immunotherapies can contribute to improved patient prognosis. Herein, we present an Austrian consensus on the systemic treatment of patients with gastric adenocarcinoma and lower gastroesophageal junction, including those with human epidermal growth factor receptor 2 (HER2)-positive disease. The consensus considers the curative setting, as well as first-line to late-line systemic treatment options in the palliative setting. For HER2-positive disease, first-line and second-line therapies are discussed, as well as HER2 testing. Potential future therapies are also listed, with a focus on anti-angiogenic treatments and checkpoint inhibition, which might provide a further step forward in the management of patients with gastric cancer.
Literatur
3.
Zurück zum Zitat FLOT4-AIO Investigators, Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–57. https://​doi.​org/​10.​1016/​S0140-6736(18)32557-1. CrossRef FLOT4-AIO Investigators, Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–57. https://​doi.​org/​10.​1016/​S0140-6736(18)32557-1. CrossRef
6.
Zurück zum Zitat Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol. 2016;17(12):1697–708. https://​doi.​org/​10.​1016/​S1470-2045(16)30531-9. CrossRefPubMed Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol. 2016;17(12):1697–708. https://​doi.​org/​10.​1016/​S1470-2045(16)30531-9. CrossRefPubMed
9.
Zurück zum Zitat GO2 Trial Investigators, Hall PS, Swinson D, Cairns DA, Waters JS, Petty R, Allmark C, et al. Efficacy of reduced-intensity chemotherapy with oxaliplatin and capecitabine on quality of life and cancer control among older and frail patients with advanced Gastroesophageal cancer: the GO2 phase 3 randomized clinical trial. JAMA Oncol. 2021;7(6):869–77. https://​doi.​org/​10.​1001/​jamaoncol.​2021.​0848. Erratum in: JAMA Oncol. 2021 Aug 1;7(8):1249. CrossRef GO2 Trial Investigators, Hall PS, Swinson D, Cairns DA, Waters JS, Petty R, Allmark C, et al. Efficacy of reduced-intensity chemotherapy with oxaliplatin and capecitabine on quality of life and cancer control among older and frail patients with advanced Gastroesophageal cancer: the GO2 phase 3 randomized clinical trial. JAMA Oncol. 2021;7(6):869–77. https://​doi.​org/​10.​1001/​jamaoncol.​2021.​0848. Erratum in: JAMA Oncol. 2021 Aug 1;7(8):1249. CrossRef
12.
Zurück zum Zitat ARTIST 2 investigators, Park SH, Lim DH, Sohn TS, Lee J, Zang DY, Kim ST, et al. A randomized phase III trial comparing adjuvant single-agent S1, S‑1 with oxaliplatin, and postoperative chemoradiation with S‑1 and oxaliplatin in patients with node-positive gastric cancer after D2 resection: the ARTIST 2 trial. Ann Oncol. 2021;32(3):368–74. https://​doi.​org/​10.​1016/​j.​annonc.​2020.​11.​017. CrossRef ARTIST 2 investigators, Park SH, Lim DH, Sohn TS, Lee J, Zang DY, Kim ST, et al. A randomized phase III trial comparing adjuvant single-agent S1, S‑1 with oxaliplatin, and postoperative chemoradiation with S‑1 and oxaliplatin in patients with node-positive gastric cancer after D2 resection: the ARTIST 2 trial. Ann Oncol. 2021;32(3):368–74. https://​doi.​org/​10.​1016/​j.​annonc.​2020.​11.​017. CrossRef
13.
Zurück zum Zitat CRITICS investigators, Cats A, Jansen EPM, van Grieken NCT, Sikorska K, Lind P, Nordsmark M, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. Lancet Oncol. 2018;19(5):616–28. https://​doi.​org/​10.​1016/​S1470-2045(18)30132-3. CrossRef CRITICS investigators, Cats A, Jansen EPM, van Grieken NCT, Sikorska K, Lind P, Nordsmark M, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. Lancet Oncol. 2018;19(5):616–28. https://​doi.​org/​10.​1016/​S1470-2045(18)30132-3. CrossRef
15.
Zurück zum Zitat Slagter AE, Jansen EPM, van Laarhoven HWM, van Sandick JW, van Grieken NCT, Sikorska K, et al. CRITICS-II: a multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. Bmc Cancer. 2018;18(1):877. https://​doi.​org/​10.​1186/​s12885-018-4770-2. CrossRefPubMedPubMedCentral Slagter AE, Jansen EPM, van Laarhoven HWM, van Sandick JW, van Grieken NCT, Sikorska K, et al. CRITICS-II: a multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. Bmc Cancer. 2018;18(1):877. https://​doi.​org/​10.​1186/​s12885-018-4770-2. CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Park SH, Sohn TS, Lee J, Lim DH, Hong ME, Kim KM, et al. Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the Adjuvant Chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol. 2015;33(28):3130–6. https://​doi.​org/​10.​1200/​JCO.​2014.​58.​3930. CrossRefPubMed Park SH, Sohn TS, Lee J, Lim DH, Hong ME, Kim KM, et al. Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the Adjuvant Chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol. 2015;33(28):3130–6. https://​doi.​org/​10.​1200/​JCO.​2014.​58.​3930. CrossRefPubMed
19.
Zurück zum Zitat Kelly RJ, Ajani JA, Kuzdzal J, Zander T, Van Cutsem E, Piessen G, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384(13):1191–203. CrossRef Kelly RJ, Ajani JA, Kuzdzal J, Zander T, Van Cutsem E, Piessen G, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384(13):1191–203. CrossRef
20.
Zurück zum Zitat Rivera F, Izquierdo-Manuel M, García-Alfonso P, Martínez de Castro E, Gallego J, Limón ML, et al. Perioperative trastuzumab, capecitabine and oxaliplatin in patients with HER2-positive resectable gastric or gastro-oesophageal junction adenocarcinoma: NEOHX phase II trial. Eur J Cancer. 2021;145:158–67. https://​doi.​org/​10.​1016/​j.​ejca .2020.12.005. CrossRef Rivera F, Izquierdo-Manuel M, García-Alfonso P, Martínez de Castro E, Gallego J, Limón ML, et al. Perioperative trastuzumab, capecitabine and oxaliplatin in patients with HER2-positive resectable gastric or gastro-oesophageal junction adenocarcinoma: NEOHX phase II trial. Eur J Cancer. 2021;145:158–67. https://​doi.​org/​10.​1016/​j.​ejca .2020.12.005. CrossRef
21.
Zurück zum Zitat Hofheinz RD, Hegewisch-Becker S, Kunzmann V, Thuss-Patience P, Fuchs M, Homann N, et al. Trastuzumab in combination with 5‑fluorouracil, leucovorin, oxaliplatin and docetaxel as perioperative treatment for patients with human epidermal growth factor receptor 2‑positive locally advanced esophagogastric adenocarcinoma: A phase II trial of the Arbeitsgemeinschaft Internistische Onkologie Gastric Cancer Study Group. Int J Cancer. 2021;149(6):1322–31. https://​doi.​org/​10.​1002/​ijc.​33696. CrossRefPubMed Hofheinz RD, Hegewisch-Becker S, Kunzmann V, Thuss-Patience P, Fuchs M, Homann N, et al. Trastuzumab in combination with 5‑fluorouracil, leucovorin, oxaliplatin and docetaxel as perioperative treatment for patients with human epidermal growth factor receptor 2‑positive locally advanced esophagogastric adenocarcinoma: A phase II trial of the Arbeitsgemeinschaft Internistische Onkologie Gastric Cancer Study Group. Int J Cancer. 2021;149(6):1322–31. https://​doi.​org/​10.​1002/​ijc.​33696. CrossRefPubMed
23.
Zurück zum Zitat Hofheinz R, Haag G, Ettrich T, Borchert K, Kretzschmar A, Teschendorf C, et al. Perioperative trastuzumab and pertuzumab in combination with FLOT versus FLOT alone for HER2-positive resectable esophagogastric adenocarcinoma: final results of the PETRARCA multicenter randomized phase II trial of the AIO. J Clin Oncol. 2020;38:4502–4502. CrossRef Hofheinz R, Haag G, Ettrich T, Borchert K, Kretzschmar A, Teschendorf C, et al. Perioperative trastuzumab and pertuzumab in combination with FLOT versus FLOT alone for HER2-positive resectable esophagogastric adenocarcinoma: final results of the PETRARCA multicenter randomized phase II trial of the AIO. J Clin Oncol. 2020;38:4502–4502. CrossRef
24.
Zurück zum Zitat Tabernero J, Hoff PM, Shen L, Ohtsu A, Shah MA, Cheng K, et al. Pertuzumab plus trastuzumab and chemotherapy for HER2-positive metastatic gastric or gastro-oesophageal junction cancer (JACOB): final analysis of double-blind, randomised, placebo-controlled phase 3 study. Lancet Oncol. 2018;19(10):1372–84. CrossRef Tabernero J, Hoff PM, Shen L, Ohtsu A, Shah MA, Cheng K, et al. Pertuzumab plus trastuzumab and chemotherapy for HER2-positive metastatic gastric or gastro-oesophageal junction cancer (JACOB): final analysis of double-blind, randomised, placebo-controlled phase 3 study. Lancet Oncol. 2018;19(10):1372–84. CrossRef
28.
Zurück zum Zitat Al-Batran SE, Pauligk C, Hofheinz R, Lorenzen S, Wicki A, Siebenhuener AR, et al. Perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esphagogastric adenocarcinoma: DANTE, a randomized, open-label phase II trial of the German Gastric Group of the AIO and the SAKK. J Clin Oncol. 2019;37(15_suppl):TPS4142–TPS4142. CrossRef Al-Batran SE, Pauligk C, Hofheinz R, Lorenzen S, Wicki A, Siebenhuener AR, et al. Perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esphagogastric adenocarcinoma: DANTE, a randomized, open-label phase II trial of the German Gastric Group of the AIO and the SAKK. J Clin Oncol. 2019;37(15_suppl):TPS4142–TPS4142. CrossRef
32.
Zurück zum Zitat REGARD Trial Investigators, Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014;383(9911):31–9. https://​doi.​org/​10.​1016/​S0140-6736(13)61719-5. CrossRef REGARD Trial Investigators, Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014;383(9911):31–9. https://​doi.​org/​10.​1016/​S0140-6736(13)61719-5. CrossRef
33.
Zurück zum Zitat RAINBOW Study Group, Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014;15(11):1224–35. https://​doi.​org/​10.​1016/​S1470-2045(14)70420-6. CrossRef RAINBOW Study Group, Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014;15(11):1224–35. https://​doi.​org/​10.​1016/​S1470-2045(14)70420-6. CrossRef
34.
Zurück zum Zitat Al-Batran SE, Bankstahl US. NCT02661971—perioperative ramucirumab in combination with FLOT versus FLOT alone for resectable esophagogastric adenocarcinoma—RAMSES—a phase II/III trial of the AIO. ClinicalTrials.gov. 2017. Al-Batran SE, Bankstahl US. NCT02661971—perioperative ramucirumab in combination with FLOT versus FLOT alone for resectable esophagogastric adenocarcinoma—RAMSES—a phase II/III trial of the AIO. ClinicalTrials.gov. 2017.
Metadaten
Titel
Neoadjuvant treatment in gastric cancer
verfasst von
Bettina Sonnweber
Marc Schaber
MD Ewald Wöll
Publikationsdatum
19.07.2022
Verlag
Springer Vienna
Erschienen in
memo - Magazine of European Medical Oncology
Print ISSN: 1865-5041
Elektronische ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-022-00823-8