Τίτλος:
Selecting a specific pre- or postoperative adjuvant therapy for
individual patients with operable gastric cancer
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Although the very high locoregional recurrence rates reported with
limited D0/D1 surgery can be reduced with extended D2 gastrectomy for
operable gastric cancer, overall relapse and survival rates remain poor
and can only be improved with adequate perioperative adjuvant treatment.
However, despite intensive research, no regimen has been established as
standard. Meta-analyses have demonstrated a marginal survival benefit
with adjuvant chemotherapy. Two recent large randomized trials for
operable gastric cancer, the MAGIC trial and the INT-0116 trial, provide
evidence that some patients may benefit from perioperative chemotherapy
and chemoradiation, respectively. However, while both trials suggest an
overall survival benefit with adjuvant treatment, they don’t provide the
harm-benefit ratio for specific subsets of patients wih different extent
of surgery (D1 or D2) and tumor stage (early (T1,2)/advanced (173,4)).
This lack of evidence complicates current therapeutic adjuvant
decisions. Estimating the risk of local and distant recurrence (high,
moderate or low) after D1 or D2 surgery in various tumor stages and the
expected harm-benefit ratio, the authors provide useful information for
decisions on adjuvant chemotherapy with or withour radiotherapy in
individual patients. Research on newer cytotoxic and targeted agents may
improve treatment efficacy. Simultaneously, advances with
microarray-based gone-expression profiling signatures may improve
individualized treatment decisions. However, the validation and
translation of these genomic classifiers as biomarkers into a completed
‘bench-to-bedside’ cycle for tailoring treatment to individuals is a
major challenge and limits inflated expectations.
Συγγραφείς:
Briasoulis, Evangelos
Liakakos, Theodore
Dova, Lefkothea and
Fatouros, Michael
Tsekeris, Pericles
Roukos, Dimitrios H. and
Kappas, Angelos M.
Περιοδικό:
Expert Review of Anticancer Therapy
Εκδότης:
TAYLOR & FRANCIS LTD LONDON
Λέξεις-κλειδιά:
adjuvant treatment; biomarkers; chemotherapy; gastric cancer; localized
disease; postoperative; preoperative; targeted therapy
DOI:
10.1586/14737140.6.6.931
