Recent updates in perioperative chemotherapy and recurrence pattern of gastric cancer

Gastrectomy with D2 lymph node dissection has become the global standard procedure for locally advanced gastric cancer to maximally reduce locoregional recurrence. In East Asia, based on the evidence of the ACTS-GC and the CLASSIC trials, postadjuvant chemotherapy with S-1 monotherapy or capecitabine and oxaliplatin after curative D2 gastrectomy is the current standard strategy. However, approximately 20% to 30% of patients still develop distant recurrence even after these postadjuvant chemotherapies, especially in those with pathological stage III disease. This review summarizes recent (2008-2018) evidence on the benefits of adjuvant therapy for locally advanced gastric cancer. JACRO GC-07, a Phase III trial, recently showed a superior 3-year recurrence-free survival of the S-1 plus docetaxel regimen in comparison to S-1 monotherapy for patients with pathological stage III gastric cancer after curative D2 gastrectomy. With regard to recent new evidence on neoadjuvant strategy, JCOG0501, a Phase III trial, did not show any superiority in 3-year overall survival (OS) of additional neoadjuvant chemotherapy with S-1/cisplatin over postadjuvant S-1 monotherapy in scirrhous type gastric cancer. Further clinical trials of neoadjuvant chemotherapy are ongoing to improve the poor prognosis for gastric cancer with extensive lymph node metastases. These trials could lead to new evidence for improved treatment of gastric cancer in the near future.