MAGIC

Summary:

MAGIC was a Randomized Controlled Trial for patients with resectable gastric cancerIt 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.


Link:

Citation:

  • Cunningham, David, et al. “Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.” New England Journal of Medicine 355.1 (2006): 11-20.Available from: doi: 10.1056/NEJMoa055531

Where?

  • UK

When?

  • Published 2006 (July 6th) in the New England Journal of Medicine (Vol. 355, No.1)

Impact Factor (IF):

  • 72.406

This study shares the findings of a Phase III Clinical Trial from the U.K. The researchers wanted to know if having chemotherapy would change the overall survival of patients having gastric cancer surgery. Patients had chemotherapy before and after surgery.

503 gastric cancer patients with an untreated Stage 2 tumor were randomly assigned to Group A or Group B. Group A had chemotherapy both before and after surgery. Group B did not receive chemotherapy.

  • Group A patients received the medicines epirubicin, cisplatin and fluorouracil (ECF routine). This was given over 3×3 week cycles So, a total of 9 weeks of therapy were completed 3-6 weeks before surgery. This was repeated again 6-12 weeks after chemotherapy. What do these drugs do?
    • Epirubicin Hypochloride Injection: this drug kills cancer cells by breaking up the structure of their genetic material. It was injected as a single dose on Day 1 of each cycle.
    • Cisplatin (CDDP/CF): this drug stops cancer from making more cells. It was also given intravenously on Day 1 of each chemotherapy cycle.
    • Fluorouracil (5-FU): this drug stops cancer from making more cells.  It may have the name ADRUCIL in Canada. It was given intravenously every day of the chemotherapy cycle.

Group B patients had surgery 6 weeks after the start of the trial. The researchers checked up on the patients for the next 5 years.

Surgery: All patients had a type of gastrectomy surgery. This could be a radical total gastrectomy or a radical distal gastrectomy. The doctor chose the type of surgery depending on where the tumor was located.

In gastric cancer, lymph nodes near the stomach can also become diseased and are taken out (known as a lymphadenectomy). The surgeon decided how many lymph nodes should be removed based on the patient’s condition. The lymph nodes were examined in the lab to determine if they had cancer cells.

Results: There were no significant differences in post-operative complications, deaths within 30 days of surgery, adverse effects and the length of hospital stay between Groups A and B. The removed tumors and lymph nodes were examined. Researchers found that tumors from Group A patients were smaller and less advanced. This means the medicine was helpful in treating the cancer.  Also, fewer lymph nodes had cancer in Group A patients than in Group B.

Group A Group B
Average tumor size 3cm 5cm
Tumor stage Generally lower Generally higher
Cancerous lymph nodes Fewer More

Group A patients lived longer without cancer than Group B patients did over at least 5 years. The average progression-free survival was around 18 months in Group A. It was about 14 months in Group B. So, the MAGIC trial showed the benefits of perioperative chemotherapy for patients with resectable gastric cancer.

Related Reading:

  1. ncbi.nlm.nih.gov/pmc/articles/PMC4517071/
    1. Smalley, Stephen R., et al. “Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection.” Journal of Clinical Oncology 30.19 (2012): 2327. Available from: doi: 10.1200/JCO.2011.36.7136
    2. This study looked at radiation combined with chemotherapy after gastric cancer surgery.  This was compared to patients only having surgery. They found that patients receiving radiation and chemotherapy were less likely to have cancer relapse and survived longer.
  2. sciencedirect.com/science/article/pii/S0748798304001118?via%3Dihub
    1. Hartgrink, H. H., et al. “Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial1.” European journal of surgical oncology 30.6 (2004): 643-649. Available from: doi: doi.org/10.1016/j.ejso.2004.04.013
    2. This study happened before the MAGIC trial. It compared chemotherapy before surgery to  surgery alone. The researchers here found no significant benefit to pairing chemotherapy with surgery. This may be because they used a different chemotherapy routine (FAMTEX: fluorouracil, doxorubicin, methotrexate) before surgery. MAGIC used the ECF routine both before and after surgery.