Neoadjuvant chemo underused in patients with advanced gastric cancer

Last Updated: 2016-01-08

By Will Boggs MD

NEW YORK (Reuters Health) - Neoadjuvant chemotherapy (NAC) remains underused in patients with advanced gastric cancer, despite evidence that it does not worsen perioperative outcomes, U.S. researchers report.

"It was surprising to see that, despite the publication of the MAGIC trial in 2006, there was no drastic increase in utilization of NAC for treatment of gastric cancer," Dr. Joyce Wong from The Pennsylvania State University, College of Medicine, in Hershey told Reuters Health by email. "Additionally, fewer than 50% of patients were enrolled in neoadjuvant protocols in 2012, despite clinical guideline recommendations."

The MAGIC trial showed significant improvements in overall survival and progression-free survival with NAC in patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus.

Dr. Wong's team used data from the National Cancer Database (NCDB) to estimate trends in NAC and to compare the perioperative outcomes between more than 5,900 patients who received NAC for surgically resectable gastric cancer and more than 10,200 who did not.

The use of NAC increased annually from 25.9% in 2003 to 46.3% in 2012, with the greatest increase occurring in academic facilities and in facilities located in the Northeast and North Central United States.

Patients who received NAC were younger, more often male, white, privately insured, with greater income and higher education, and less morbid than those who did not receive NAC, the researchers report in Surgery, online December 16.

NAC was associated with slightly shorter hospital stays (by an average 0.43 days) and significantly lower 30-day mortality (2.2% with NAC versus 5.0% without NAC; p<0.0001 after adjustment).

Ninety-day mortality was also lower in the NAC group than in the no-NAC group, but the difference was not significant after adjustment for other factors.

"Given that the majority of those diagnosed in the U.S. have advanced gastric cancer, the majority should be undergoing NAC," Dr. Wong said. "Increasing patient understanding about the treatment options for gastric cancer, as well as increasing the awareness in the oncology and surgical communities about the truly multidisciplinary nature of gastric cancer treatment, will hopefully help increase these rates."

"In this study, NAC did not adversely affect perioperative outcomes," Dr. Wong said. "Available clinical evidence demonstrates survival benefit to NAC, and so we should be striving to see that all patients with gastric cancer receive multidisciplinary care with an oncologist as well as surgeon."

SOURCE: bit.ly/1mI1XRE

Surgery 2015.