ESMO E-Learning: Advances in Gastric Cancer: How to Approach Localised Disease

In this E-Learning module, the authors explain the latest clinical recommendations in terms of how to approach patients with localised gastric cancer. They illustrate the module with findings from recent clinical trials and elaborate changes in clinical practice based on the results from recent studies.

This module is a completely new edition based on the latest evidence from the clinical trials in the field of localised gastric cancer. It has been organised with the intention to replace a previously existing ESMO E-Learning module in that area.

In particular, the authors emphasise the new standards in the management of patients with localised gastric cancer that consist in taking the following steps: clinical assessment and staging, multidisciplinary team discussion, FLOT preoperative treatment in clinical stages II and III, surgical resection after FLOT chemotherapy, pathology assessment and estimation of risk, and postoperative chemotherapy, if tolerated.

The authors discuss the benefits of perioperative chemotherapy and evidence level I based on well designed and properly conducted randomised trials. They underline that FLOT regimen is a new standard of care.
The quality of surgery is essential. Patients with diagnosis of localised gastric cancer require a multidisciplinary team approach.

Patients with microsatellite instability don’t seem to benefit from adjuvant or neoadjuvant chemotherapy.

In this module, the authors also elaborate experimental approaches in localised gastro-oesophageal adenocarcinomas. In that regard they report that postoperative chemoradiation is of limited value if D2 surgery is performed or in case of preoperative chemotherapy. Preoperative chemoradiation is under scrutiny in one trial. Radiotherapy is still experimental. No biological agents (bevacizumab) should be used in this setting. Further research on biological predictive factors is needed. The addition of trastuzumab vs. trastuzumab/pertuzumab is under investigation in one study. Treatments with immune checkpoint inhibitors are experimental in this setting.

This E-Learning module is an excellent educational activity for all those who need an update on recent clinical practice changing approaches in the management of patients with localised gastric cancer.