Adjuvant and neoadjuvant therapy of gastric cancer: a comparison of three pivotal studies

In the past, the role of adjuvant therapy for gastric cancer was indefinite. However, three large, randomized controlled trials have recently shown the survival benefit of adjuvant therapy over surgery alone: the American INT 0116 trial, with adjuvant chemoradiation therapy; the European MAGIC trial, with perioperative combination chemotherapy; and the Japanese ACTS-GC trial, with adjuvant monotherapy. Because the patient populations and surgical approaches are considerably different among these trials, it is not sensible to simply compare survival rates to determine the best modality. In the time since these pivotal trials, various innovative studies have been planned and launched to evaluate treatment factors including modality (chemotherapy or chemoradiation), timing (before and/or after surgery), and different surgical extent (D1 or D2 lymphadenectomy). Because the East and West have different backgrounds and treatments for localized gastric cancer, each region should design its own clinical trial to determine the best evidence-based treatment regimens.