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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(06): 832-840
DOI: 10.4103/ijmpo.ijmpo_188_20
Original Article

Does Neoadjuvant Chemotherapy Increase the Survival in Patients with Locally Advanced Gastric Cancer Patients? – A Real‑World Evidence

Murugesan Janarthinakani
Department of Medical Oncology, Madras Cancer Care Foundation, Chennai, Tamil Nadu, India
,
Selvaraj Kalaiselvi
Department of Community Medicine, AIIMS, Nagpur, Maharashtra, India
,
Rajamani Priyadarshini
Department of Research, Fenivi Research Solutions Private Limited, Chennai, Tamil Nadu, India
,
Seshachalam Arun
Department of Medical Oncology, GVN Cancer Institute, Trichy, Tamil Nadu, India
,
K Shashidhar
Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
,
R Krishnakumar
Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
,
N Manjunath
Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
,
Sirigeri Roopa
Department of Oncology, Columbia Asia, Bengaluru, Karnataka, India
,
SG Raman
Department of Medical Oncology, Madras Cancer Care Foundation, Chennai, Tamil Nadu, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Background: In locally advanced gastric cancer (LAGC), perioperative chemotherapy has shown to improve the survival to a larger extent compared to surgery alone. In India, the treatment followed for gastric carcinoma widely varies based on the type of health-care provider and treatment access. There is a paucity of data on the role of neoadjuvant chemotherapy on survival among LAGC patients in the Indian context. Aim: The aim of this study was to compare the disease-free survival (DFS) and overall survival (OS) between neoadjuvant and adjuvant chemotherapies among LAGC patients. Subjects and Methods: This was a retrospective cohort study involving clinical record review of LAGC patients enrolled between 2015 and 2017 from four tertiary cancer centers in South India. The date for the following events, namely diagnosis, recurrence, death, and last day of visit, was extracted in a mobile-based open-access tool. The median duration of OS and DFS between the neoadjuvant and adjuvant groups was compared using Kaplan–Meier survival curves. Results: Of the 137 patients, 70 (51%) had received neoadjuvant chemotherapy followed by surgery and 67 (49%) had adjuvant chemotherapy following the surgery. The mean (standard deviation) age of participants was 55.4 (11.4) years. Seventy-eight percent of the patients were diagnosed at Stage 3 or 4. Regional lymph nodes were involved in 83.9%. The median duration of follow-up was 15 months. The OS in the neoadjuvant and adjuvant groups was 18.6 months and 8.3 months, respectively. Nonregional lymph node involvement and adjacent organ involvement had independently increased the risk of death. Conclusion: Among LAGC patients, the neoadjuvant chemotherapy indicated a better median and DFS compared to the adjuvant group. However, these findings were statistically not significant. The current study has contributed an important finding to the existing evidences of clinical practice in an Indian setting. Further large-scale studies are required to validate the promising trend of using neoadjuvant chemotherapy in LAGC.

Keywords

Collaborative Medical Oncology Group - D2 lymphadenectomy - gastric carcinoma - stomach neoplasm - Structured Operational Research and Training Initiative


Publication History

Received: 24 April 2020

Accepted: 23 October 2020

Article published online:
14 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 International Agency for Research on Cancer. GLOBOCAN Cancer Fact Sheets: Stomach Cancers. International Agency for Research on Cancer.2008
  • 2 Indian Council of Medical Research.Consensus Document for Management of Gastric Cancer.New Delhi: Indian Council of Medical Research; 2014
  • 3 Global Burden of Disease. GBD Compare IHME Viz Hub. Global Burden of Disease; 2013.
  • 4 Sitarz R, Skierucha M, Mielko J, Offerhaus GJ, Maciejewski R, Polkowski WP. Gastric cancer: Epidemiology, prevention, classification, and treatment. Cancer Manag Res 2018; 10: 239-48
    Search in Google Scholar
  • 5 Dikken JL, van de VeldeCJ, Coit DG, Shah MA, Verheij M, Cats A. Treatment of resectable gastric cancer. Therap Adv Gastroenterol 2012; 5: 49-69
    CrossrefPubMedSearch in Google Scholar
  • 6 Park SC, Chun HJ. Chemotherapy for advanced gastric cancer: Review and update of current practices. Gut Liver 2013; 7: 385-93
    CrossrefPubMedSearch in Google Scholar
  • 7 Mirza A, Pritchard S, Welch I. The postoperative component of MAGIC chemotherapy is associated with improved prognosis following surgical resection in gastric and gastrooesophageal junction adenocarcinomas. Int J Surg Oncol 2013; 2013: 781742
    PubMedSearch in Google Scholar
  • 8 Glynne-Jones R, Grainger J, Harrison M, Ostler P, Makris A. Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: Should we be more cautious? . Br J Cancer 2006; 94: 363-71
    CrossrefPubMedSearch in Google Scholar
  • 9 Eom BW, Kim S, Kim JY, Yoon HM, Kim MJ, Nam BH. et al. Survival benefit of perioperative chemotherapy in patients with locally advanced gastric cancer: A propensity score matched analysis. J Gastric Cancer 2018; 18: 69-81
    CrossrefPubMedSearch in Google Scholar
  • 10 Glatz T, Bronsert P, Schäfer M, Kulemann B, Marjanovic G, Sick O. et al. Perioperative platin-based chemotherapy for locally advanced esophagogastric adenocarcinoma: Postoperative chemotherapy has a substantial impact on outcome. Eur J Surg Oncol 2015; 41: 1300-7
    CrossrefPubMedSearch in Google Scholar
  • 11 Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de VeldeCJ, Nicolson M. et al Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20
    CrossrefPubMedSearch in Google Scholar
  • 12 Earle CC, Maroun J, Zuraw L. Cancer Care Ontario Practice Guidelines Initiative Gastrointestinal Cancer Disease Site Group. Neoadjuvant or adjuvant therapy for resectable gastric cancer? A practice guideline. Can J Surg 2002; 45: 438-46
    PubMedSearch in Google Scholar
  • 13 Ministry of Health and Family Welfare Government of India. Achievements Under National Cancer Control Programme. Ministry of Health and Family Welfare Government of India
  • 14 Shrikhande SV, Sirohi B, Barreto SG, Chacko RT, Parikh PM, Pautu J. et al. Indian Council of Medical Research. consensus document for the management of gastric cancer. Indian J Med Paediatr Oncol 2014; 35: 239-43
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T. et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011; 29: 4387-93
    CrossrefPubMedSearch in Google Scholar
  • 16 Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH. et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): A phase 3 open-label, randomised controlled trial. Lancet 2012; 379: 315-21
    CrossrefPubMedSearch in Google Scholar
  • 17 Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G. et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: An FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011; 29: 1715-21
    CrossrefPubMedSearch in Google Scholar
  • 18 Chelakkot PG, Ravind R, Sruthi K, Menon D. Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms. Indian J Cancer 2019; 56: 74-80
    CrossrefPubMedSearch in Google Scholar
  • 19 Hartgrink HH, van de VeldeCJ, Putter H, Songun I, Tesselaar ME, Kranenbarg EK. et al Neo-adjuvant chemotherapy for operable gastric cancer: Long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 2004; 30: 643-9
    CrossrefPubMedSearch in Google Scholar
  • 20 Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: A systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006; 24: 2903-9
    CrossrefPubMedSearch in Google Scholar
  • 21 Sharma A, Radhakrishnan V. Gastric cancer in India. Indian J Med Paediatr Oncol 2011; 32: 12-6
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Ahmed BM, Wani KA, Wani M. OP0003 Feasibility and efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer: A randomised trial. Eur J Cancer 2015; 51: e1 -2
    CrossrefSearch in Google Scholar
  • 23 Chalissery JR, Jose TA, Pillai S, Unni H, Varghese KM, Gopu GP. et al. Clinical impact of adjuvant chemotherapy and radiation for carcinoma stomach: Experience from a tertiary care center. J Can Res Ther. 2020
  • 24 Sharma A, Raina V, Lokeshwar N, Deo SV, Shukla NK, Mohanti BK. Phase II study of cisplatin, etoposide and paclitaxel in locally advanced or metastatic adenocarcinoma of gastric/gastroesophageal junction. Indian J Cancer 2006; 43: 16-9
    CrossrefPubMedSearch in Google Scholar
  • 25 Shukla NK, Deo SV, Asthana S, Raina V, Dronamaraju SS. et al. Neonatal. Neonat 2013; 2: 4-7
    Search in Google Scholar
  • 26 Kushwaha AK, Vidyarthi SK. Neoadjuvant chemotherapy in locally advanced stomach cancer: Our experience. J Carcinog Mutagen 2019; 10: 1-2
    Search in Google Scholar
  • 27 Ibrahim M, Gilbert K. Management of gastric cancer in Indian population. Transl Gastroenterol Hepatol 2017; 2: 64
    CrossrefPubMedSearch in Google Scholar
  • 28 Ostwal V, Sahu A, Ramaswamy A, Sirohi B, Bose S, Talreja V. et al. Perioperative epirubicin, oxaliplatin, and capecitabine chemotherapy in locally advanced gastric cancer: Safety and feasibility in an interim survival analysis. J Gastric Cancer 2017; 17: 21-32
    CrossrefPubMedSearch in Google Scholar
  • 29 Chawla T, Thambudorai R, Ashok A, Roy B, Ghosh J, Ganguly S. et al. Perioperative chemotherapy with docetaxel, oxaliplatin, fluorouracil and leucovorin (FLOT) versus epirubicin, platinum and capecitabine or flourouracil (EOX/ECF) in resectable gastric or gastroesophageal junction adenocarcinoma: Safety and response data from India. Ann Oncol 2019; 30: 252-324
    CrossrefSearch in Google Scholar