The Advances in Gastrointestinal Cancer Resource Centre Introduction
The Advances in Gastrointestinal Cancer Resource Centre is dedicated to disseminating cutting edge data to practising healthcare professionals. Our aim is to provide clinically relevant information in order to enhance the caregivers' ability to provide optimal care for their gastrointestinal (GI) cancer patients. We will offer journal articles, patient case reports, interviews, and roundtable discussions with experts, with additional content aimed at expanding your expertise in the multidisciplinary field of GI cancer. This freely available resource, hosted by European Journal of Cancer and Clinical Colorectal Cancer, will function as a hub of information for healthcare professionals.
Our initial focus for Advances in Gastrointestinal Cancer will centre on gastric cancer, with future expansion to all GI malignancies. New content will be posted monthly, and the Editors encourage you to visit the site regularly to stay abreast of recent scientific developments in GI cancers. Please subscribe to our eAlert to ensure you are informed of all new content as it is published on this platform.
Articles of the Month
Br J Surg. 2016 Apr 4. [Epub ahead of print]
Selected and commented by Professor David Cunningham:
This month, there are a number of interesting studies published relating to the neoadjuvant treatment of oesophageal cancer. In the British Journal of Surgery, Bekkar et al. present the results of a large retrospective European study on the effects of neoadjuvant chemoradiotherapy on Stage I and II oesophageal cancer, a group of patients which are less well represented in clinical trials. Using propensity matched scoring to adjust for differences in baseline characteristics, they demonstrate that patients treated with neoadjuvant chemotherapy (typically cisplatin and fluoropyrimidine based) had better disease free and overall survival compared to those who did not receive pre-operative chemotherapy. The improvement in overall survival appeared to be driven by a reduction in distant metastases (21.9% vs. 27.1%; p = 0·035) as loco-regional recurrences and mixed recurrences occurred at similar rates in both groups. The study emphasised that understaging is common in patients with clinical Stage I and II disease, almost one third of patients had pathological stage III disease at surgery. This further supports a neo-adjuvant chemotherapy approach as micrometastases which lead to recurrence are more common in Stage III cancers and these may be eliminated by chemotherapy.
Clinical T2N0 Esophageal Cancer: Identifying Pretreatment Characteristics Associated With Pathologic Upstaging and the Potential Role for Induction Therapy
Ann Thorac Surg. 2016 Apr 12. [Epub ahead of print]
Selected and commented by Professor David Cunningham:
The implications of understaging are also highlighted in a manuscript by Samson et al. in Annals of Thoracic Surgery. The authors reviewed the cases of 932 clinically stage T2N0 patients who received upfront surgery, and 853 clinical T2N0 patients who received induction therapy prior to surgery. Almost half (45.7%) of patients who underwent upfront surgery were upstaged at surgery, of these 44.2% received adjuvant chemotherapy. For patients upstaged at upfront resection median overall survival was worse than for patients who received neoadjuvant chemotherapy (43.9 months versus 27.5 months, p < 0.001), however this difference was mitigated in patients who received adjuvant chemotherapy following upfront surgery (43.8 months versus 34.6 months, p = 0.14). However, as approximately half of patients do not have a performance status sufficient to allow safe delivery of adjuvant therapy following oesophagogastrectomy, neoadjuvant treatment is likely to be helpful for a greater number of patients.
Panitumumab added to docetaxel, cisplatin and fluoropyrimidine in oesophagogastric cancer: ATTAX3 phase II trial
Tebbutt NC, Price TJ, Ferraro DA, Wong N, Veillard AS, Hall M, et alBr J Cancer. 2016 Mar 1;114(5):505-9
Bevacizumab combined with docetaxel, oxaliplatin, and capecitabine, followed by maintenance with capecitabine and bevacizumab, as first-line treatment of patients with advanced HER2-negative gastric cancer: A multicenter phase 2 study
Meulendijks D, de Groot JW, Los M, Boers JE, Beerepoot LV, Polee MB, et alCancer. 2016 May 1;122(9):1434-43.
A phase II prospective study of the trastuzumab combined with 5-weekly S-1 and CDDP therapy for HER2-positive advanced gastric cancer
Kataoka H, Mori Y, Shimura T, Nishie H, Natsume M, Mochizuki H, et al.Cancer Chemother Pharmacol. 2016 Mar 22. [Epub ahead of print]
Prospective phase II trial of pazopanib plus CapeOX (capecitabine and oxaliplatin) in previously untreated patients with advanced gastric cancer
Kim ST, Lee J, Lee SJ, Park SH, Jung SH, Park YS, Lim HY, Kang WK, Park JOOncotarget. 2016 Mar 18. [Epub ahead of print]
Evaluation of Angiopoietin-2 as a biomarker in gastric cancer: results from the randomised phase III AVAGAST trial
Hacker UT, Escalona-Espinosa L, Consalvo N, Goede V, Schiffmann L, Scherer SJ, et alBr J Cancer. 2016 Apr 12;114(8):855-62
Interviews from The European Cancer Congress, Vienna, September, 2015
Professor Lordick introduces news and his personal highlights from the recent European Cancer Congress 2015 which took place in Vienna, Austria, 25-29. Highlights include the symposium, The why, the which, and the how of targeting angiogenesis in GI malignancies and a topic of particular interest was the peri-operative chemotherapy of locally advanced gastric cancer.
Professor Trevor Leong discusses a randomised trial, TOPGEAR, which compares pre-operative chemo-radiation with pre-operative chemotherapy alone for patients with resectable gastric cancer. The background of this trial is that currently the optimal adjuvant strategy for patients with gastric cancer is unknown. In Western countries there are two standards of care. There is either postoperative chemo radiation or peri-operative chemotherapy using ECF. So what this trial does is it compares chemo radiation to chemotherapy alone in the adjuvant setting but with the advantage of bringing the chemo radiation in the pre-operative setting which has a lot of advantages compared to post-operative treatment.