Adjuvant treatment for locally advanced gastric cancer: an Asian perspective

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 27; no. 3; pp. 439 - 450
• Main Authors: Kim, Hyung-Don, Ryu, Min-Hee, Kang, Yoon-Koo
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.05.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Adjuvant therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Chemotherapy; Chemotherapy, Adjuvant; Clinical outcomes; Clinical trials; Gastrectomy; Gastrectomy - methods; Gastric cancer; Gastroenterology; Humans; Medicine; Medicine & Public Health; Neoadjuvant Therapy - methods; Neoplasm Staging; Oncology; Pathology; Patients; Perioperative care; Radiology; Review Article; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Surgery; Surgical Oncology; Survival analysis; Neoadjuvant chemotherapy; Adjuvant chemotherapy; Asia; Gastric cancer
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-024-01484-8

Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens.