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Treatment of Localised Gastric Cancer - news from the ECC Congress in Vienna, September 2015

Interview_Florian_Lordick_ECC

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.

Peri-operative chemotherapy with EGF: MAGIC study

Standard therapy is defined by the British MAGIC study consisting of pre-operative chemotherapy with epirubicin, cisplatin and fluorouracil (ECF) followed by resection and adjuvant chemotherapy again. The addition of the peri-operative regimen improved significantly the outcome in overall survival.

Ramucirmab for second-line therapy

Addition of antiangiogenic agents to this standard regime have been investigated in the STO3-study. Bevazicumab, a monoclonal antibody against vascular endothelial growth factor (VEGF) didn’t further improve the outcome when added to the peri-operative standard. Despite this finding with Bevazicumab in the peri-operative setting, targeting VEGF receptor-2 with the monoclonal ramucirumab showed benefits in second-line treatment of advanced gastric cancer.

Peri-operative chemoradiotherapy

Another approach in the peri-operative phase was the addition of radiotherapy to the regime epirubicin, cisplatin and capecitabine followed by surgery and adjuvant chemotherapy. First results with 120 patients from 700 show a slight increase in post-operative complications but no increase in post-operative mortality. The study has now proceeded to phase III.

Docetaxel-based chemotherapy: FLOT4 trial

A third promising approach in the peri-operative setting is the replacement of epirubicin by a taxane – docetaxel. The results of the FLOT4 study presented by Al-Batran at the ASCO and ECC 2015 show that the histopathological response rate is tripled. 2016/2017 will reveal if there is benefit in overall survival of the FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) versus ECF regimen.

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ECCO2017 symposium webcast: Treatment evolution in advanced GI malignancies

Welcome and introduction - Florian Lordick

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