Précis: The routine use of adjuvant therapy for patients with gastric carcinoma apperrs difficult to justify.
In 1998, gastric cancer was the 9th leading cause of cancer related death in the United States and the second leading cause in the world. The symptoms and/or signs of gastric cancer are generally nonspecific and the majority of patients present with advanced disease. Routine screening for gastric cancer is generally not performed in western countries because of the low prevalence of the disease. When the tumor is respectable, curative surgery is the mainstay of treatment. Adjuvant therapies have been investigated extensively for more than 30 years. This report by Drs. Shimada and Ajani is a comprehensive review of the role of adjuvant therapy for this disease.
All randomized studies since 1984 were reviewed.
There were some marked differences in the strategies employed between the West and Asia.
Postoperative adjuvant therapy did not appear to be beneficial in Western studies.
The results of the Asian trials demonstrated a benefit to adjuvant therapy; however, only in subgroup analyses of patients with relatively early stage disease was this benefit observed.
Despite lack of definitive evidence for efficacy, most Asian patients receive postoperative or perioperative adjuvant chemoimmunothearpy.
The routine use of adjuvant therapy for patients with gastric carcinoma is difficult to justify. Further investigation using novel anticancer agents with unique mechanisms of action, such as angiogenesis inhibitors, metalloproteinase inhibitors, antibodies to oncogenes, or gene therapy, are warranted.