CaGCA Projects

On May 4th, the CaGCA and CSSO hosted the 2024 Annual Canadian Gastric Cancer Conference in Toronto, Canada. This conference provided a comprehensive update on the multidisciplinary approach to gastric cancer management, as well as presentations of the most up to date data on gastric cancer treatment in fields from GI, Pathology, Surgery and Medical/Radiation Oncology.

The event included lectures, panel discussions, interactive questions, and “How I Do It” videos pertaining to gastric cancer treatment  and management. We were privileged to have our patients join us via MyGutFeeling, a patient advocacy group, in order to share their perspectives with us.

Our highly skilled speakers include Dr. Eric Van Cutsem, MD, PhD; Dr. Lorenzo Ferri, MD, FRCSC; Dr. Lucy K Helyer, MD, MSc, FRCS; Dr. Trevor Hamilton, MD, MSc, FRCSC; Katy Kosyachova, Vice-Chair & Co-Founder of MyGutFeeling; Dr. Howard Lim, MD, PhD, FRCSC; Dr. Lloyd Mack, MD, FRCSC; Dr. Dan Schiller, MD, FRCSC; Dr. Stephanie Snow, MD, FRCSC; and Teresa Tiano, Chair & Co-Founder of MyGutFeeling.

Our Keynote Speaker, Dr. Eric Van Cutsem is a professor and Division Head of Digestive Oncology at University Hospitals Gasthuisberg & University of Leuven, Belgium. In 2018 he became doctor honoris causa of the Medical University of Warsaw, Poland and received several national and international awards, such as the ESMO Award and the European Awards in Medicine for Cancer Research. He is amongst the highest cited researchers at the University of Leuven and worldwide in the domain of Gastrointestinal cancer, as well as the top 3 most cited Medical Scientists in Belgium, with research interests including aspects of both Gastrointestinal and Digestive cancers. He was chairman of the governmental colon cancer prevention task force in Flanders, Belgium, is active as president and treasurer of Belgian Group Digestive Oncology and as president/vice-president of Familial Polyposis Association (FAPA), and is a member of the governmental commission of recognition for specialists in gastroenterology and digestive oncology. Dr. Eric Van Cutsem provided us with an engaging lecture regarding current updates in Her2-targeted treatments in Gastric Cancer, as well as the newest combination of Her-2 targeted therapy with immunotherapy in gastric cancer. Dr. Cutsem also led the dinner keynote regarding new therapies for gastric cancer.

Dr. Howard Lim delivered updates on Neoadjuvant therapies in Gastric Cancer, describing the recent data of peri-operative immunotherapy in GC, as well as peri-operative systemic therapy in GC. Dr. Adam Meneghetti and Dr. Farhana Shariff provided us with a lecture on Optimizing Nutrition in Gastric Cancer Management, with both surgical and nutritional considerations. Dr. Dan Schiller provided an update on the CaGCA Database, discussing the development of a nation-wide database and the current scope of the Canadian Gastric Cancer Database. Dr. Lorenzo Ferri spoke on how to better select patients for systemic treatments, how to select patients for the appropriate management when considering their genetic subtype, as well as the newest approaches to tailored medicine based on molecular subtypes of gastric cancer. Dr. Lucy Helyer and Dr. Lloyd Mack partook in a debate regarding HIPEC being offered as an option to gastric cancer patients by discussing the latest data on the role of heated intraperitoneal chemotherapy for patients with gastric cancer, as well as possible indications/contra-indications to consideration of referral of gastric cancer patients for surgery with HIPEC.

Thank you to all attendees, patients, speakers, sponsors, and both national and international partners and members for attending and making this year’s conference possible.

CaGCA at IGCC (Prague, 2019)

Best posters → Young Investigators (IGCC-0821)

Population Registry of Esophageal and Stomach Tumours in Ontario (PRESTO): a multicentre clinical and pathological database including over 25,000 patients

V. Gupta, J. Levy, C. Allen-Ayodabo, E. Amirazodi, Y. Jeong, L. Davis, Q. Li, E. Hseih, J. Conner, A. Mahar, J. Ringash, R. Sutradhar, B. Kidane, G. Darling, N. Coburn

Objectives

Esophagogastric cancers carry a high mortality and their incidence is rising in North America and Europe. There is a need to monitor and improve care for this disease. We developed a clinical and pathological database of esophagogastric cancers to study practice patterns, resource utilization, and clinical outcomes.

Methods

Adults with esophagogastric cancer diagnosed from 2002-2015 in Ontario, Canada were identified through the Ontario Cancer Registry. Pathology reports for this cohort were obtained and abstracted by two physicians. These data were linked to clinical administrative data capturing physician services, hospital visits, vital statistics, and census information. Pathologic characteristics of patients undergoing resection are presented. The protocol allows for ongoing updates to the cohort.

Results

A population registry including 25,906 esophagogastric cancer patients was created. Pathologic information from diagnostic procedures and surgical resections, including cancer stage, tumour size, lymph node yield, and surgical margin status, is available for the cohort. Inter-rater reliability showed high concordance between two abstractors. Linkage to administrative data was achieved through deterministic algorithms. For 3604 esophageal and 1856 gastric cancer resections, a median of 16 (IQR 10-23) and 17 nodes (IQR 11-24) were resected, respectively. Most patients had T3 disease (46% esophageal, 35% gastric). Only 36% of patients presented with node-negative disease. Majority of patients (45% esophageal, 55% gastric) had poorly or undifferentiated tumours.

Conclusions

The PRESTO study will enable population-level study of treatment patterns, geographic variation, resource utilization, and clinical outcomes for esophagogastirc cancer. This will be a valuable addition to the global efforts in optimizing care for this disease.

Best posters → Surgery and quality assurance (IGCC-0903)

Cancer surgery centre designation and the clinical and economic outcomes of patients with gastric cancer

Jeong, J. Hallet, A. Mahar, N. Mittmann, V. Gupta, L. Bubis, N. Coburn

Objectives

Gastric cancer (GC) care is associated with high clinical and economic burden. Cancer surgery centre designation (CSCD) was established for quality and safety assurance in the treatment of hepatopancreatobiliary and thoracic cancers in North America. Despite similar surgical care complexity, morbidity, and mortality, no such designation exists specific to GC treatment. Specialized treatment programs, however, may be more costly. We compared clinical and economic outcomes for GC patients between institutions with and without CSCD.

Methods

A retrospective cohort study was conducted on patients diagnosed with non-metastatic GC between 2002 and 2014, and treated with gastrectomy. Linked administrative data were used to evaluate 90-day mortality, overall survival, and care costs for GC patients treated at centres with and without CSCD. Multivariable analysis was used to adjust for clinically relevant covariates. Parameter estimates with 95% confidence intervals (CI) were derived. Costs were inflated to 2016 United States dollars.

Results

A total of 2,930 patients with resected GC were identified (CSCD n=1,436; non-CSCD n=1,494). CSCD was associated with lower 90-day mortality (OR 0.70, 95% CI 0.52-0.94, p=0.02), and similar overall survival (HR 0.94, 95% CI 0.85-1.04, p=0.24). Adjusted mean monthly costs were $2,400 (95% CI $1,728-$3,332) for the CSCD group, and $2,487 (95% CI $1,790- $3,455) for the non-CSCD group (p=0.36).

Conclusions

Centralization of surgical care to institutions with CSCD may result in lower 90-day mortality, and similar overall survival, with no difference in costs to the healthcare system, for the care of patients with GC.

PW02-Poster session with poster walks II Abstract: P.07-385-Fri

Hospital Gastrectomy Volume Predicts Adequate Lymphadenectomy in Gastric Adenocarcinoma

J. Levy, V. Gupta, N. Jivraj, C. Allen-Ayodabo, E. Amirazodi, Q. Li, A. Mahar, C. De Mestral, O. Saarela, N. Coburn

Objectives

Previous studies have established the association between surgical volume and mortality in gastric cancer. Oncologic outcomes are an important part of surgical quality. We sought to assess the association between hospital volume and lymph node dissection.

Methods

Adult patients diagnosed with gastric adenocarcinoma between 2004 and 2016 were identified through the Ontario Cancer Registry. Database linkage was used to capture relevant clinical and pathology data. A multivariable logistic model accounting for relevant confounders was used to determine the association between annual gastrectomy hospital volumes and adequate lymph node harvest, defined as greater than 16 lymph nodes.

Results

A total of 1,749 patients were identified and stratified into three hospital volume groups: 0-4, 5-8, and 9+ gastrectomy cases annually. There were 580, 620 and 549 patients in each group, respectively. Age, comorbidity index, tumor location, histology (intestinal vs. diffuse), grade, T-Stage and N-Stage were evenly distributed across groups (p>0.05). The median number of lymph nodes resected by increasing volume group was 15 (IQR 9-22), 17 (IQR 11-24) and 18 (IQR 13-26) (p<0.001). The proportion of patients with adequate lymph nodes harvested by increasing volume group was 45%, 53% and 58% (p<0.001). Patients in the highest and intermediate volume groups were 65% (aOR 1.65; 95% CI 1.23-2.12) and 36% (aOR 1.36; 95% CI 1.07-1.73) more likely to undergo an adequate lymphadenectomy compared to the lowest volume group.

Conclusions

Increased hospital experience in gastric cancer surgery improves lymph node dissection, with the potential to improve patient staging and prognosis.

PW02-Poster session with poster walks II Abstract: P.07-386-Fri

Variation in Gastric Cancer Outcomes in North America

J. Levy, V. Gupta, N. Jivraj, E. Amirazodi, C. Allen-Ayodabo, Q. Li, O. Saarela, N. Coburn

Objectives

Outcomes for gastric cancer patients has been shown to be variable internationally. We sought to compare primary tumour resection, lymph node harvest and survival rates in patients with gastric adenocarcinoma across health care systems in North America.

Methods

Adult patients with gastric adenocarcinoma between 2004 and 2015 were identified from the US Surveillance, Epidemiology, and End Results (SEER) cancer registry and the Canadian Ontario Cancer Registry (OCR). Linked administrative data were used to capture relevant information. Pathology reports were identified and abstracted for a subgroup analysis. Outcomes included primary tumour resection, lymph node harvest and 3-year survival rates.

Results

In total, 57,600 American and 10,649 Canadian patients were identified. Resection rates were greater in the U.S. (43% vs. 32%, p<0.001). 3-year survival rates in patients undergoing gastrectomy were 46% in the U.S. SEER and 50% in Ontario (p<0.001). In non-resected patients the 3-year survival rates were 9% in the U.S. SEER and 16% in Ontario (p<0.001). The subgroup analysis included 24,551 American and 1,669 Canadian patients. The proportion of patients with greater than 16 lymph nodes resected was 39% in the US compared to 50% in Canada (p<0.001). Stage-stratified 3-year survival rates in the US compared to Canada were 71% vs. 82% (p<0.001) in Stage I, 45% vs. 68% (p<0.001) in Stage II, 27% vs. 42% (p<0.001) in Stage III and 17% vs. 28% (p<0.001) in Stage IV patients.

Conclusions

Stage-based survival outcomes in Ontario are superior than in the U.S. SEER, which may be due to judicious selection for gastrectomy.

PW01-Poster session with poster walks I Abstract: P.09-618-Thu

TOPGEAR: A phase II/III trial of preoperative chemoradiotherapy versus preoperative chemotherapy for resectable gastric cancer: Comparison of FLOT versus ECX/F.

Michael, F. Lordick, B.M. Smithers, J. Zalcberg, J. Simes, M. Findlay, V. Gebski,R. O’Connell, D. Miller, C. Aiken, S. York, R. Wong, K. Haustermans, C. Swallow, G. Darling, A. Strickland, M. Lee, J. Ringash, M. Thomas, T. Leong

Objectives

TOPGEAR is a multinational randomised phase II/III trial evaluating if neoadjuvant chemoradiotherapy (CRT) added to ECX/F chemotherapy is superior to chemotherapy alone in patients (pts) with resectable gastric cancer. The FLOT4-AIO trial showed the FLOT regimen superior to ECF/X in this setting. From November 2017, the FLOT regimen has been incorporated into the TOPGEAR trial. We report here the toxicity and surgical rates of those patients treated with FLOT versus ECF/X in TOPGEAR.

Methods

Eligible patients: operable gastric/GOJ adenocarcinoma, stage IB–IIIC, potentially treated with radical radiotherapy. Treatment arms: (i) Control, (Arm-A): ECX/Fx3 or FLOTx4, followed by surgery, then the same chemotherapy (ii) Experimental, (Arm-B): ECX/Fx2 or FLOTx3 + ChemoRT (45Gy/1.8Gy#s/CI 5FU or X), followed by surgery then ECX/Fx3 or FLOTx4.

Results

To date, 444 patients recruited, 393 have completed treatment. 68 patients have received FLOT. Toxicity: For patients who have completed treatment (Arms A and B), Grade III/IV AEs FLOT vs ECX/F: (i) haematological: 51.9% vs 47.1% (ii) gastrointestinal: 18.5% vs 28.9%, (iii) neurological: 2.2% vs 0.0%. Toxicity differences were not significant between regimens and regardless of treatment arm, P >0.05. Surgical rates: Overall (Arms-A and -B), 357 patients underwent surgery: FLOT, (N =41, 36 [87.8%]) vs ECF/X (N =371, 321 [86.5%]), P =0.819. In Arm B, there was no difference in surgical resection rates between regimens (P =0.730).

Conclusions

The addition of FLOT to the ongoing TOPGEAR trial, has had no significant impact on, toxicity nor surgical resection rates relative to the ECX/F regimen. Recruitment continues.