Researchers from Italy have reported that adjuvant FOLFOX-4 (leucovorin, 5-FU, and oxaliplatin) for eight cycles and concomitant radiotherapy “is feasible and effective for the treatment of patients with high-risk gastric cancer.” The details of this study were published in the March 2010 issue of the Archives of Surgery.1

There have been several randomized trials to determine the efficacy of adjuvant therapy in the treatment of resected gastric cancer. A review article in the September 1, 2005, issue of the Journal of Clinical Oncology evaluated all the relevant studies to date.2 These reviewers stated that the results of a large North American Study (Gastrointestinal Cancer Intergroup Trial INT 0116) showing that postoperative chemoradiotherapy conferred a survival advantage compared with surgery alone has led to a new standard of care in the United States. After a thorough review of this subject, the authors concluded that more studies were needed to optimize therapy and to move to a better consensus and standardization of care. Since this time there have been both positive and negative studies concerning adjuvant therapies for resected gastric cancer. Most of the positive studies come from Asia, especially Japan, where the incidence of gastric cancer is high. These studies have suggested that adjuvant chemotherapy without radiation therapy is effective. For instance, researchers from Japan have previously reported that an oral fluoropyrimidine, S-1, improves survival by 10% in patients with resected Stage II-III gastric cancer.

The current study involved 29 patients with Stage III-IV gastric cancer who had previous curative surgery. All received adjuvant FOLFOX-4 and radiotherapy, which was begun after the first two cycles of chemotherapy.

• “Disease-free and overall survival rates at 1, 2, and 3 years were 79%, 35% and 35% and 85%, 62.6%, and 50.1%, respectively.”
• “Severe hematologic and gastrointestinal toxic effects occurred in 10% and 33%, respectively.”

These authors suggest that these results are superior to those observed in patients treated with surgery alone.

Comments: This study may help optimize adjuvant therapy for patients with advanced but operable gastric cancer.

Reference: