Optimal Duration of Adjuvant Chemotherapy for Gastric Cancer: Might Less Be More?

Abstract

https://jgc-online.org Several large-randomized trials have indicated that adjuvant chemotherapy after curative resection with D2 lymph node dissection has a significant survival benefit in Asian patients with resectable gastric cancer. Adjuvant chemotherapy in Asian patients with resectable gastric cancer is primarily supported by the results of 2 large, randomized phase 3 trials: the Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer (ACTS-GC) and the Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer (CLASSIC) [1,2]. Based on the results of these trials, both chemotherapy regimens (S-1 for 1 year or capecitabine plus oxaliplatin for 6 months) are currently accepted in East Asia as standard adjuvant chemotherapy regimens for pathological stage II or III gastric cancer after D2 gastrectomy [3,4]. However, as S-1 monotherapy has limited survival benefits in patients with stage III gastric cancer, oral fluoropyrimidine-based doublet regimens (capecitabine plus oxaliplatin [XELOX], S-1 plus oxaliplatin [SOX], or S-1 plus docetaxel) are recommended as adjuvant chemotherapy for these patients [2-6] (Fig. 1A).