Past research

The last two decades have seen a number of important clinical trials in gastric cancer. Please find some of the highlights of significant research in this field, below:

Chemotherapy with surgery (curative)

MAGIC: 

  • MAGIC was a Randomized Controlled Trial for patients with resectable gastric cancer. It looked at the effects of surgery with, versus without chemotherapy. Patients who had chemotherapy before and after surgery lived longer than patients who only received surgery.

MacDonald: 

  • Can chemoradiotherapy lower the risk of gastric cancer coming back after surgery? This experiment found that chemotherapy and radiation given together after gastrectomy was helpful when compared to surgery alone. This combination increased survival and reduced the chance of getting cancer again. The chemotherapy medications used were fluorouracil and leucovorin.

CLASSIC:

  • What are the effects of having chemotherapy after surgery? This trial compared two groups patients having a gastrectomy. One group was given chemotherapy after surgery. The other group was not. The drugs studied were capecitabine and oxaliplatin. The researchers measured the survival of patients and the recurrence of cancer. They found that the chemotherapy was helpful.

Chemotherapy with surgery (advanced gastric cancer)

REGATTA:

  • Advanced gastric cancer patients normally do not have surgery. The authors of this study wanted to know if a gastrectomy with chemotherapy would help patients with advanced gastric cancer. They found that the gastrectomy with chemotherapy was not helpful when compared to giving chemotherapy alone.

Specifically comparing chemo routines

FLOT 4:

  • Which chemotherapy routine is better for patients having gastric cancer surgery? This study compared two options. Routine A (ECF/ECX) was epirubicin, cisplatin and either fluorouracil or capecitabine. Routine B (FLOT) was docetaxel, oxaliplatin, leucovorin and fluorouracil. Overall, the FLOT routine was better for this patient group.

Perioperative peritoneal therapy regimes

EPIC:

  • How useful is early postoperative intraperitoneal chemotherapy (EPIC) with a gastrectomy in treating resectable gastric cancer? EPIC is a way to give chemotherapy medications directly at the site of cancer in the peritoneum. It is given right after surgery while the patient is still in the operating room. This study found that EPIC can increase survival in patients with Stage 3 cancer, even though it may cause some more side effects, when compared to just surgery.

Neoadjuvant Intraperitoneal Systemic Chemotherapy (NIPS):

  • Can neoadjuvant intraperitoneal systemic chemotherapy (NIPS) help surgeons remove more cancer cells during a gastrectomy? NIPS is a chemotherapy method which gives drugs directly to the peritoneum for a few weeks before surgery. This is done using a catheter tube. In this experiment, some patients had NIPS before gastrectomy. The researchers found that these patients had fewer cancer cells remaining in their belly after the surgery. So, NIPS can be helpful before surgery to more completely remove cancer cells.

HIPEC:

  • How useful is hyperthermic intraperitoneal chemotherapy (HIPEC) when given on top of cytoreductive surgery (CRS)? HIPEC gives warmed chemotherapy medicine directly to the cancer site during surgery. This study found that HIPEC increased survival compared to the group that only had surgery.

GYMSSA:

  • Is multimodal therapy or standard systemic chemotherapy better at treating metastatic gastric cancer? One group of patients in this trial received multimodal therapy. This consisted of surgery with both hyperthermic intraperitoneal chemotherapy and systemic chemotherapy. The other group of patients received only systemic chemotherapy. The study found that multimodal therapy significantly increased survival in this small experiment.

Surgical techniques

KLASS-01:

  • Is an open or laparoscopic gastrectomy approach better to use for patients with Stage 1 Gastric cancer? Traditional gastrectomy surgeries are done by creating a large cut in the belly. This way, the surgeon can have access to a larger area. The laparoscopic method is newer. It makes a smaller cut and uses specialized tools with a camera to see inside. This study found that laparoscopic surgery can be a safe way to treat early stage gastric cancer.

Chemotherapy and radiation

CRITICS:

  • Can a combination of chemotherapy with radiation improve survival when compared to chemotherapy only after surgery? One group in this clinical trial was given chemoradiotherapy after gastric cancer surgery. The other group received chemotherapy, but no radiation. There was no significant difference between the groups.

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference:

  • This paper recaps an important Gastric Cancer conference from 2015. It contains up-to-date information about gastric cancer in Canada. It mainly talks about diagnosing and treating the disease. The paper is meant to help doctors learn about the best treatments for their patients. A summary of some of the major talking points from this conference are here.