Giulia Grizzi1, Fausto Petrelli2, Maria Di Bartolomeo3, Matteo Viti4, Mariana Texeira Moraes4, Andrea Luciani5, Rodolfo Passalacqua1, Michele Ghidini6, Gianluca Tomasello6, Gian Luca Baiocchi7, Andrea Celotti7. 1. Oncology Unit, ASST Cremona, Cremona, CR, Italy. 2. Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy. faupe@libero.it. 3. Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, MI, Italy. 4. Surgical Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy. 5. Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy. 6. Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 7. Department of Surgery, ASST Cremona, Cremona, CR, Italy.
Abstract
INTRODUCTION: Currently, the standard treatment for gastric and gastroesophageal junction (GEJ) adenocarcinoma, including distal esophagus, consists of perioperative chemotherapy (CT) according to FLOT schedule (5FU/leucovorin/oxaliplatin and docetaxel), or of concomitant chemoradiotherapy (CTRT) based on CROSS regimen. However, due to the relatively lack of direct comparisons between perioperative CT and neoadjuvant CTRT, the effectiveness of these new combinations is unknown. Therefore, we performed a network meta-analysis (NMA) to compare the efficacy of different neoadjuvant treatments for gastric and GEJ adenocarcinoma in terms of overall and disease-free survival (OS and DFS). MATERIALS AND METHODS: We searched MEDLINE, Embase, and Cochrane from database inception until February 1st 2022 for randomized clinical trials that enrolled adults with gastric and GEJ carcinomas and provided data about OS and/or DFS. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (95% CrIs). Surface under the cumulative rank (SUCRA) curve plots were produced. The primary outcome was OS, secondary endpoint DFS. RESULTS: A total of 1247 citations were screened; 14 randomized clinical trials were included. In Bayesian comparisons, FLOT-based CT ranked as one of the better regimens with a probability of 41%, both with induction CT followed by CTRT (P = 0.45). For DFS analysis, the FLOT regimen was the preferred option (P = 0.62). CONCLUSIONS: In conclusion, this NMA adds further evidence to the optimization of treatment strategies for gastric and GEJ adenocarcinomas and confirms that incorporation of perioperative triplet-based CT improved both OS and DFS compared to surgery alone and other preoperative strategies.
INTRODUCTION: Currently, the standard treatment for gastric and gastroesophageal junction (GEJ) adenocarcinoma, including distal esophagus, consists of perioperative chemotherapy (CT) according to FLOT schedule (5FU/leucovorin/oxaliplatin and docetaxel), or of concomitant chemoradiotherapy (CTRT) based on CROSS regimen. However, due to the relatively lack of direct comparisons between perioperative CT and neoadjuvant CTRT, the effectiveness of these new combinations is unknown. Therefore, we performed a network meta-analysis (NMA) to compare the efficacy of different neoadjuvant treatments for gastric and GEJ adenocarcinoma in terms of overall and disease-free survival (OS and DFS). MATERIALS AND METHODS: We searched MEDLINE, Embase, and Cochrane from database inception until February 1st 2022 for randomized clinical trials that enrolled adults with gastric and GEJ carcinomas and provided data about OS and/or DFS. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (95% CrIs). Surface under the cumulative rank (SUCRA) curve plots were produced. The primary outcome was OS, secondary endpoint DFS. RESULTS: A total of 1247 citations were screened; 14 randomized clinical trials were included. In Bayesian comparisons, FLOT-based CT ranked as one of the better regimens with a probability of 41%, both with induction CT followed by CTRT (P = 0.45). For DFS analysis, the FLOT regimen was the preferred option (P = 0.62). CONCLUSIONS: In conclusion, this NMA adds further evidence to the optimization of treatment strategies for gastric and GEJ adenocarcinomas and confirms that incorporation of perioperative triplet-based CT improved both OS and DFS compared to surgery alone and other preoperative strategies.
Authors: Joel Shapiro; J Jan B van Lanschot; Maarten C C M Hulshof; Pieter van Hagen; Mark I van Berge Henegouwen; Bas P L Wijnhoven; Hanneke W M van Laarhoven; Grard A P Nieuwenhuijzen; Geke A P Hospers; Johannes J Bonenkamp; Miguel A Cuesta; Reinoud J B Blaisse; Olivier R C Busch; Fiebo J W Ten Kate; Geert-Jan M Creemers; Cornelis J A Punt; John Th M Plukker; Henk M W Verheul; Ernst J Spillenaar Bilgen; Herman van Dekken; Maurice J C van der Sangen; Tom Rozema; Katharina Biermann; Jannet C Beukema; Anna H M Piet; Caroline M van Rij; Janny G Reinders; Hugo W Tilanus; Ewout W Steyerberg; Ate van der Gaast Journal: Lancet Oncol Date: 2015-08-05 Impact factor: 41.316
Authors: S Kim; S Paget-Bailly; M Messager; T Nguyen; P Mathieu; N Lamfichekh; F Fein; S Fratté; D Cléau; Z Lakkis; M Jary; N Sakek; M Jacquin; A Foubert; F Bonnetain; C Mariette; F Fiteni; C Borg Journal: Eur J Surg Oncol Date: 2016-06-29 Impact factor: 4.424