Dr. Mehta on the Evolution of Treatment in Gastric and GEJ Cancers

Rutika J. Mehta, MD, MPH, a medical oncologist specializing in gastrointestinal cancer at Moffitt Cancer Center, discusses how treatment has evolved in recent years for gastric and gastroesophageal junction (GEJ) cancers.

Depending on which institution a patient goes to, GEJ cancers can be treated similarly to esophageal or gastric cancers, says Mehta. There are 2 schools of thought on this, but GEJ cancers and gastric cancers are commonly grouped together for clinical trial purposes, says Mehta.

In the locally advanced setting, the standard has always been perioperativechemotherapy. Until a few years ago, the standard approach was epirubicin-based treatment with 3 cycles given preoperatively and 3 cycles given postoperatively; this is commonly referred to as a “sandwich”approach, notes Mehta.

The combination of 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel has become the new standard of care in recent years, surpassing the median overall survival benefit we had previously seen, while eliciting impressive pathologic complete response rates, as well, adds Mehta.

Thus, epirubicin-based therapy should now be reserved for patients with locally advanced gastric cancer who are otherwise candidates for surgery, concludes Mehta.