From the Guidelines
Perioperative chemotherapy with the ECF regimen significantly improves progression-free survival in patients with operable gastric and lower esophageal adenocarcinomas. Progression-free survival (PFS) in resectable gastric cancer refers to the length of time during and after treatment that a patient lives without the cancer growing or spreading. It is measured from the start of treatment until disease progression or death from any cause. In resectable gastric cancer, PFS is an important clinical endpoint used to evaluate the effectiveness of treatments, particularly in the neoadjuvant (pre-surgery) and adjuvant (post-surgery) settings.
Key Factors Influencing PFS
- Tumor stage
- Lymph node involvement
- Surgical margin status
- Response to neoadjuvant therapy
- Molecular characteristics of the tumor According to the study published in the Journal of the National Comprehensive Cancer Network 1, the use of perioperative chemotherapy with epirubicin, cisplatin, and 5-FU (ECF) resulted in improved progression-free and overall survival in patients with operable gastric and lower esophageal adenocarcinomas. The study found that the perioperative chemotherapy group had a greater proportion of pathologic T1 and T2 tumors (51.7%) than the surgery group (36.8%), and five-year survival rates were 36% among those who received perioperative chemotherapy and 23% in the surgery group.
Treatment Options
- Perioperative chemotherapy with ECF regimen
- Surgical resection The results of this study have established perioperative chemotherapy as another added option to the standard of care for patients with resectable gastric cancer, highlighting the importance of considering chemotherapy in addition to surgery to improve patient outcomes, including progression-free survival 1.
From the Research
Definition of Progression-Free Survival
Progression-free survival (PFS) refers to the length of time during and after treatment that a patient lives with a disease, such as cancer, without the disease worsening. In the context of resectable gastric cancer, PFS is an important metric for evaluating the effectiveness of different treatment strategies.
Studies on Progression-Free Survival in Resectable Gastric Cancer
Several studies have investigated PFS in patients with resectable gastric cancer, including:
- A study published in 2010 2 that discussed the results of the MAGIC/UK Medical Research Council (MRC) trial, which demonstrated that perioperative chemotherapy resulted in an improvement in overall survival and progression-free survival.
- A randomized phase II trial published in 2020 3 that reported a 5-year PFS of 51.2% in patients who received neoadjuvant chemotherapy and 40.3% in patients who received perioperative chemotherapy.
- A retrospective study published in 2019 4 that found that patients who received perioperative chemotherapy-desktop showed an improved progression-free survival, although the difference was not statistically significant.
- A study published in 2012 5 that discussed various treatment strategies for resectable gastric cancer, including perioperative chemotherapy and postoperative chemoradiation, but did not provide specific data on PFS.
- A study published in 2024 6 that reported on the survival outcomes of patients with resectable gastric cancer treated with total neoadjuvant therapy, but did not provide specific data on PFS.
Key Findings
The key findings from these studies are:
- Perioperative chemotherapy can improve PFS in patients with resectable gastric cancer 2, 3, 4.
- The 5-year PFS rates for patients with resectable gastric cancer can vary depending on the treatment strategy, ranging from 40.3% to 51.2% 3.
- Total neoadjuvant therapy may be associated with promising survival outcomes, including high rates of treatment completion and pathologic complete response 6.
Treatment Strategies
The treatment strategies for resectable gastric cancer that have been investigated in relation to PFS include: