OP0003 Feasibility and efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer: A randomised trial

Background Long term survival after curative resection for locally advanced gastric cancer is still low; 5-year survival after diagnosis is 10–21%. Neoadjuvant chemotherapy allows higher curative (R0) resection rates to be achieved and treats micrometastases early. The present study was undertaken to evaluate the feasibility and efficacy of NACT in gastric cancer. Methods Fifty patients were enrolled and randomised into two groups. Group A received epirubicin, cisplatin, and fluorouracil (ECF regimen) and group B received cisplatin, calcium leucovorin, and fluorouracil (CCF regimen). The aim of this study was compare the efficacy of the two neoadjuvant regimens in terms of curative resection rate. Findings Twenty four of 25 patients in group A and 22 of 25 patients in group B received three to four cycles of chemotherapy. No deaths were reported in either group. Haematological adverse effects were seen more in group A whereas non-hematological effects were seen more in group B, with the exception of nausea and alopecia, which were more common in group A. Complete responses were seen in two patients in group A. Partial responses were seen in 17 (68%) patients in group A and 14 (56%) in group B. Two (8%) patients in group A and four (16%) patients in group B progressed to metastatic disease. Curative resection was achieved in 18 (72%) patients in group A and 16 (64%) in group B. Partial pathological responses were seen more with ECF than with CCF (38.9% versus 25%). Median progression-free survival was 14.8 months in group A and 13.4 months in group B. Overall survival at 24 months median follow-up was 52% in group A and 44% in group B. Interpretation Neoadjuvant chemotherapy in locally advanced gastric cancer is safe and improves the curative resection rate, decreases recurrence, and improves survival.