Chemo and surgery may be helpful for some with gastric cancer

Last Updated: 2017-05-04

By David Douglas

NEW YORK (Reuters Health) - Neoadjuvant chemotherapy followed by surgery may improve survival in patients with limited metastatic gastric or gastroesophageal junction cancer, according to German researchers.

As Dr. Salah-Eddin Al-Batran told Reuters Health by email, this trial "is a first step towards answering a long-lasting question: will we be able to cure patients with metastatic gastric cancer one day?"

For the study, a phase 2 trial, Dr. Al-Batran of UCT-University Cancer Center, in Frankfurt am Main, and colleagues studied 238 patients whose disease was classified as being resectable, limited metastatic or extensive metastatic.

The resectable group received four preoperative cycles of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) and then surgery followed by four postoperative cycles. The limited-metastatic group received at least four cycles of neoadjuvant FLOT. Patients who had favorable prognostic factors proceeded to surgery. The extensive-metastatic group was offered FLOT chemotherapy and surgery only if required for palliation.

Median follow-up for surviving patients was 28.6 months and median overall survival (OS) was not achieved in patients in the resectable group, but compared favorably with that in the limited metastatic group.

In the limited-metastatic group, OS was 22.9 months and in the extensive-metastatic group, it was 10.7 months. Corresponding response rates were 60% and 43.3%. In all, 36 of the 60 patients with limited metastatic disease underwent surgery and had an OS of 31.3 months, compared to 15.9 months in those who did not.

Thus, the researchers conclude, "Patients with limited metastatic disease who received neoadjuvant chemotherapy and proceeded to surgery showed a favorable survival."

They go on to point out that these findings provide "a rationale for further randomized clinical trials." And in fact, the results of a phase 3 trial are expected to be announced in June.

The AIO-FLOT3 trial was supported by grants from Sanofi. Dr. Al-Batran has received grants from Sanofi and other companies as have other authors.

SOURCE: http://bit.ly/2pKwtyM

JAMA Oncol 2017.