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.
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).
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.
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
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Academic Medical Center.
Has not received any funding.
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.