From the Guidelines
The optimal treatment for resectable gastric cancer is surgical resection combined with perioperative chemotherapy, with the FLOT regimen (docetaxel combined with oxaliplatin and 5-FU/leucovorin) being the preferred chemotherapy regimen, as it has demonstrated a prolonged median disease-free survival and median OS, higher pathological response rate, and R0 resection rate with a more tolerable profile 1.
Treatment Overview
The treatment of resectable gastric cancer involves a multidisciplinary approach, including surgery, chemotherapy, and radiation therapy.
- Surgical resection is the primary treatment for resectable gastric cancer, with a gastrectomy (partial or total removal of the stomach) and D2 lymph node dissection being the standard surgical procedure.
- Perioperative chemotherapy is recommended, with the FLOT regimen being the preferred chemotherapy regimen.
- Alternative chemotherapy regimens include FOLFOX (fluorouracil, leucovorin, oxaliplatin) or CAPOX (capecitabine, oxaliplatin).
Chemotherapy Regimens
The choice of chemotherapy regimen depends on the individual patient's condition and the stage of the cancer.
- The FLOT regimen has been shown to be superior to the ECF/ECX regimen in terms of disease-free survival and overall survival 1.
- Other chemotherapy regimens, such as FOLFOX and CAPOX, may also be considered.
Adjuvant Therapy
Adjuvant therapy, including chemoradiation or chemotherapy alone, may be considered for patients who are unable to receive perioperative chemotherapy.
- The choice of adjuvant therapy depends on the individual patient's condition and the stage of the cancer.
- Regular follow-up with endoscopy, imaging, and tumor marker testing is essential to monitor for recurrence after treatment completion.
Nutritional Support
Nutritional support is crucial for patients with gastric cancer, as many experience malnutrition.
- Patients should receive nutritional support before and after surgery to ensure optimal nutrition and reduce the risk of complications.
Multidisciplinary Team Discussion
A multidisciplinary team discussion is essential to determine the best treatment plan for each patient.
- The team should include surgeons, medical and radiation oncologists, gastroenterologists, radiologists, and pathologists.
- The team should discuss the individual patient's condition, the stage of the cancer, and the best treatment options to ensure optimal care.
From the FDA Drug Label
- 4 Gastric Adenocarcinoma Docetaxel Injection in combination with cisplatin and fluorouracil is indicated for the treatment of patients with advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who have not received prior chemotherapy for advanced disease.
The optimal treatment for resectable gastric (stomach) cancer is not directly stated in the provided drug label. The label only mentions the treatment of advanced gastric adenocarcinoma with Docetaxel Injection in combination with cisplatin and fluorouracil. Since the label does not explicitly address resectable gastric cancer, no conclusion can be drawn about the optimal treatment for this specific condition 2.
From the Research
Optimal Treatment for Resectable Gastric Cancer
The optimal treatment for resectable gastric cancer involves a multidisciplinary approach, including surgery, chemotherapy, and radiation therapy.
- Surgery is the only curative therapy for gastric cancer, with standard recommendations including free-margin surgery with at least D1 resection and the removal of a minimum of 15 lymph nodes 3.
- Adjuvant chemoradiation has been shown to confer a survival advantage compared with surgery alone, as demonstrated by the Gastrointestinal Cancer Intergroup Trial INT 0116 3.
- Perioperative chemotherapy has also been shown to improve overall survival and progression-free survival, as demonstrated by the MAGIC/UK Medical Research Council (MRC) trial 3.
- Other treatment options include preoperative chemotherapy and chemoradiation, which have been explored in several small randomized studies with encouraging results 4.
Current Standard of Care
The current standard of care for resectable gastric cancer is still according to a one-size-fits-all approach, despite the fact that gastric cancer is a heterogeneous disease with respect to patient-, tumor-, and molecular characteristics 5.
- Treatment options for patients with resectable gastric cancer include perioperative chemotherapy, pre- or postoperative chemoradiotherapy, and postoperative chemotherapy 5.
- Ongoing research is focused on personalizing therapy for patients with resectable gastric cancer, including the use of molecular subtyping and potential biomarkers to improve patient selection 6.
Areas of Research
Current areas of research include:
- Intensified chemotherapy (in neoadjuvant, perioperative, and adjuvant settings) 6.
- Pre- and postoperative chemoradiation in combination with chemotherapy 6.
- The role of biologics and targeted therapy in the treatment of resectable gastric cancer 6, 4.
- The use of novel molecular targeting agents in the multimodality treatment of gastric cancer 4.