Adjuvant S-1 Chemotherapy for Gastric Cancer and Peritoneal Wash

Adjuvant S-1 Chemotherapy for Gastric Cancer and Peritoneal Wash,10.1007/s00268-010-0807-7,World Journal of Surgery,John Spiliotis,Odysseas Zoras

Adjuvant S-1 Chemotherapy for Gastric Cancer and Peritoneal Wash   (Citations: 1)
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In the September issue of the World Journal of Surgery, Ito and colleagues evaluated the efficacy of postoperative S-1 chemotherapy in patients with stage II/III gastric cancer with detection by a real-time reverse transcription polymerase chain reaction (RT-PCR) of free intraperitoneal cancer cells [1]. Based on the results of a large-scale, appropriately designed, multicenter, Japanese, Phase III, randomized controlled trial (RCT) [2], postoperative S-1 chemotherapy has become a standard adjuvant treatment in Japanese patients with stage II/III gastric cancer after standardized gastrectomy with D2 lymphadenectomy. In this changing treatment study, adjuvant S-1 chemotherapy reduced peritoneal recurrence in the subgroup analysis. However, that trial was not designed to evaluate the efficacy of S-1 treatment in stage II/III patients with a positive peritoneal wash on RT-PCR. Ito and colleagues [1] looked at whether adjuvant S-1 treatment was effective also in the subgroup of patients with molecular detection of peritoneal micrometastases in patients with gastric cancer by quantifying carcinoembryonic antigen (CEA) mRNA in peritoneal washes. From a total of 32 patients with CEA mRNA(?) gastric cancer, 20 patients (37.5%) relapsed, 10 of whom showed peritoneal relapse. The authors compared these findings with those of historical controls and found that the 3-year survival rates for the study population and the controls were similar (67.3% vs. 67.1%, respectively). The authors concluded that S-1 monotherapy seems not to be effective in eradicating free cancer cells in the abdominal cavity. If this is true, all patients with stage II/III should undergo a peritoneal wash during D2 surgery because CEA mRNA(?) may influence the decision-making about postoperative adjuvant S-1 treatment. However, this is a small retrospective comparison study with historical controls, which suggests major limitations in terms of drawing conclusions. The authors might better have performed a Phase II trial to assess a potential role of CEA mRNA. If such a study had positive results, a Phase III RCT could then be satisfied. Current efforts to improve oncologic outcomes of patients with stage II/III disease have focused on the addition of adjuvant radiotherapy to S-1 or cisplatin-based combination chemotherapy. Moreover, the positive results of a Phase III trial adding trastuzumab to HER2-positive patients with advanced or metastatic gastric cancer [3] drive new clinical trials of adjuvant treatment with trastuzumab plus combination chemotherapy. Exciting emerging research explores other mutated genes that influence other signaling pathways, such as HER1 and HER3 downstream pathways as well as signaling pathway networks important for gastric cancer metastasis. The advent of the latest DNA sequencing technology raises rational optimism for improving outcomes of patients with gastric cancer or other solid cancers [4–15].
Journal: World Journal of Surgery - WORLD J SURGERY , vol. 35, no. 2, pp. 468-469, 2011
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