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Perioperative Chemotherapy Improves Survival in Gastric Cancer: Presented at ASCO

By Michael Smith

ORLANDO, FL -- May 16, 2005 -- Chemotherapy before and after surgery improves survival for patients with cancer of the stomach and lower third of the esophagus, researchers reported here May 14^th at the American Society for Clinical Oncology Annual Meeting (ASCO).

The MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial is the first to show a benefit for perioperative chemotherapy, although American studies have shown a benefit for chemotherapy after surgery, said David Cunningham, MD, head, Gastrointestinal Unit, Royal Marsden Hospital, Surrey, United Kingdom.

The study should prompt a change in Europe, where the standard of care for patients with gastric cancer is surgery alone, Dr. Cunningham said.

In North America, where the standard practice is to offer postoperative chemotherapy and radiation, "this represents an alternative to offer patients after surgery," he added.

The study of 503 patients showed that 3 weeks of chemotherapy before surgery, and 3 weeks afterward improved overall survival from 23% to 36% 5 years after diagnosis, he said. The result was statistically significant at the confidence level of P = .0009.

As well, 70% of the patients who received chemotherapy had disease progression compared with 83% of those who got surgery alone.

The chemotherapy regimen consisted of 3 cycles of epirubicin, cisplatin, and infused 5-fluorouracil 3 weeks apart, both before and after surgery.

The survival benefit is significant, Dr. Cunningham said, in view of the fact that more than 1 million cases of gastric cancer are diagnosed every year around the world.

The advantage of the perioperative approach is that it allows time for the chemotherapy to shrink the tumor, making it easier for surgeons to remove it, he said, and added that on average, tumors shrank from 5 to 3 cm.

Previous American studies involved patients after surgery, and the study populations were therefore already highly selected. By contrast, Dr. Cunningham said, "We take all comers."


[Presentation title: Perioperative Chemotherapy in Operable Gastric and Lower Oesophageal Cancer: Final Results of a Randomised, Controlled Trial (The MAGIC Trial, ISRCTN 93793971). Abstract 4001]

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