Abstract 1713
Background
Alternatives in treatment-strategies exist for resectable gastric cancer treated with curative intent including: perioperative chemotherapy, adjuvant chemoradiotherapy and adjuvant chemotherapy. Our aims were (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent.
Methods
PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to August 2017 for randomized controlled trials on curative treatment for resectable gastric cancer. We performed two network-meta-analyses (NMA). NMA-1 compared perioperative, neoadjuvant and adjuvant strategies only if there was a direct comparison. NMA-2 compared different adjuvant regimens with chemotherapy or chemoradiotherapy, after curative resection. Overall-survival (OS) and disease-free-survival (DFS) were analyzed using random-effects NMA on the hazard ratio (HR)-scale and calculated as combined HRs and 95% credible intervals (95%CrIs).
Results
NMA-1 consisted of 9 direct comparisons between strategies for OS (14 studies, n = 4,187 patients). NMA-2 consisted of 16 direct comparisons between adjuvant chemotherapy/chemoradiotherapy regimens for OS (37 studies, n = 10,761) and 14 for DFS (30 studies, n = 9,714 patients). Compared to taxane-containing-perioperative-chemotherapy, surgery-alone (HR = 0.58, 95%CrI = 0.38-0.91) and perioperative-chemotherapy (HR = 0.79, 95%CrI = 0.58-1.15) were inferior in OS. Compared to surgery-alone neoadjuvant chemotherapy was non-significant (HR = 1.00, 95%CrI = 0.67-1.47). After curative-resection, the doublet oxaliplatin-fluoropyrimidine (for one-year) was the most efficacious adjuvant regimen in OS (HR = 0.47, 95%CrI = 0.28-0.80). The addition of radiotherapy to chemotherapy did not improve OS and DFS.
Conclusions
For resectable gastric cancer treated with curative intent, (1) taxane-containing perioperative-chemotherapy is the preferred treatment strategy; and (2) adjuvant oxaliplatin-fluoropyrimidine is the optimal regimen after curative resection.
Clinical trial identification
Legal entity responsible for the study
Academic Medical Center.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
S.S. Gisbertz: Consultant: Medtronic; Unrestricted research grant: Olympus. M.G.H. van Oijen: Unrestricted research grants: Bayer, Lilly, Merck Serono, Nordice, Roche. H.W.M. van Laarhoven: Consultant: Philips, Celgene, Lilly, Nordic; Unrestricted research funding: Philips, Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Roche. All other authors have declared no conflicts of interest.
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