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Treatment of Localised Gastric Cancer - news from the ECC Congress in 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.
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.
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.