Title:Prognostic Significance of Pre- And Post-Operative Tumour Markers for Patients With Gastric Cancer.

[K drug combined with trastuzumab and chemotherapy are significantly effective in HER-2-positive advanced gastric cancer ]

ToGA study proves that first-line chemotherapy combined with trastuzumab can improve the overall survival rate of patients with HER-2-positive advanced gastric cancer. This study evaluated the efficacy and safety of K-drug (Pembrolizumab) combined with trastuzumab and chemotherapy in the first-line treatment of HER-2-positive advanced gastroesophageal carcinoma (including gastric, esophageal, or gastroesophageal junctional cancer).

This is an open, non-random, single-arm, single-center Phase II clinical trial. Patients with HER-2 positive advanced gastric cancer had a PS score of 0-2 and a left ventricular ejaculation fraction of ≥53%. The medication regimen is: the initial induction dose of pembrolizumab 200 mg and the initial load dose of trastuzumab 8 mg/kg. Then every 21 days, oxaliplatin 130 mg/m² d1 intravenous injection (or cisplatin 80 mg/m²); capecitabine 850 mg/m² bid, q2w (or 5-FU 800 mg/m² d1-5), and pembrolizumab 200 mg, trastuzumab maintenance dose 6 mg/kg d1. The primary endpoint was PFS at 6 months, defined as patients receiving trastuzumab and pembrolizumab at least once survived at 6 months and had no progression of the disease. A total of 37 patients were recruited in the

study, reaching the primary endpoint: 26 patients had no progression at 6 months (70%; 95% CI: 54-83). The median PFS reached 13.0 months (95% CI: 9.3-NR), the median OS reached 27.3 months (95% : 18.8-NR), the DCR was 100%, and the ORR was 97%. Common treatment-related adverse events of are neuropathy (36 [97%]); common grade 3/4 adverse events are lymphopenia (7 [19%] in grade 3, 2 [5%] in grade 4), electrolyte disorders (6 [16%] in grade 3), and anemia (4 [11%] in grade 3). Two patients developed grade 3 nephritis, resulting in interruption of treatment. Pembolizumab was discontinued due to immune-related adverse events. The safety of pembrolizumab combined with trastuzumab and chemotherapy is controllable and has encouraging activity in HER-2-positive advanced gastroesophageal carcinoma. The Phase III clinical trial Keynote-811 will further verify the results.

Title: First-line Pembrolizumab and Trastuzumab in HER2-positive Oesophageal, Gastric, or Gastro-Oesophageal Junction Cancer: An Open-Label, Single-Arm, Phase 2 Trial.

Journal: Lancet Oncol(35.386). Pub Date: 2020 May 18.

Author: Yelena Y Janjigian, Steven B Maron, Walid K Chatila, et al.

Address: DOI: 10.1016/S1470-2045(20)30169-8

[Effects of apatinib in the real world for treating advanced gastric cancer]

More than one clinical trials have proved the efficacy and safety of apatinib in chemotherapy above the second line of advanced gastric cancer. The researchers evaluated the performance of apatinib in the real world. A total of 747 patients with advanced gastric cancer were included in the

study and received low doses of apatinib (500mg or 250mg qd). The results showed that the median PFS was 5.56 months (95% CI: 4.47-6.28) and the median OS was 7.5 months (95% 6.74-8.88). Four patients achieved CR, 47 patients achieved PR, 374 patients had stable disease, ORR was 6.83%, and DCR was 56.89%. The main adverse reactions are hypertension, proteinuria, hand and foot syndrome, fatigue, anemia, leukopenia, thrombocytopenia and neutropenia. No treatment-related deaths occurred.

Small dose apatinib is effective in the real world for the treatment of advanced gastric cancer and has controllable adverse reactions.

Title: Effectiveness and Safety of Low-Dose Apatinib in Advanced Gastric Cancer: A Real-World Study.

Journal: Cancer Med(3.357). Pub Date: 2020 May 22.

Author: Yingying Du, Qisheng Cao, Congqiao Jiang, et al.

Address: DOI: 10.1002/cam4.3105

【Is the use of PPI related to the risk of gastric cancer? 】

Previous studies have suggested that proton pump inhibitors (PPI) and H2 histamine receptor antagonists will increase the risk of gastric cancer, which has raised questions about the safety of inhibiting gastric acid. Therefore, the investigators conducted a case-control study based on the Scottish Primary Medical Clinical Informatics Department (PCCIU) database and conducted a cohort study in the UK biodatabase.

study matched five control cases in the PCCIU with a case diagnosed with gastric cancer from 1999 to 2011, and determined the medications taken based on records, using conditions Logsitic regression to calculate OR and 95% CI.In the UK Biodatabase, medication administration was reported independently by subjects when they entered the cohort study between 2006 and 2010. The researchers confirmed cases of gastric cancer before 2014 based on the tumor registry and calculated HR using Cox regression.

PCCIU included 1119 gastric cancer cases and 5394 control cases. UK Biodatabase included 250 cases from 471,779 subjects. One year after use, PPI users showed a higher risk of gastric cancer in both PCCIU and UK biodatabases (adjusted OR=1.49, 95%CI: 1.24-1.80; adjusted HR=1.28, 95%CI: 0.86-1.90). However, the correlation weakened at 2 years after use (adjusted OR=1.13, 95%CI: 0.91-1.40; adjusted HR=1.15, 95%CI: 0.73-1.82).

Overall, there is no consistent evidence that using PPI increases the risk of gastric cancer.

Title: Use of Proton Pump Inhibitors and histamine-2 Receptor Antagonists and Risk of Gastric Cancer in Two Population-Based Studies.

Journal: Br J Cancer(5.416). Pub Date: 2020 May 5.

Author: Peipei Liu, Úna C McMenamin, Brian T Johnston, et al.

Address: DOI:10.1038/s41416-020-0860-4

[Can HER-2-positive stage IV gastric cancer patients benefit from active preoperative combined treatment and radical surgery? 】

HER-2-positive stage IV gastric cancer (GC) or gastroesophageal carcinoma ligand cancer (EGJ) after receiving trastuzumab (T-mab) combined with chemotherapy, some patients have tumors remission and can undergo radical surgery. This study aims to evaluate the clinical efficacy of preoperative T-mab combined with radical gastrectomy in patients with HER-2-positive stage IV gastroesophageal cancer.

A total of 199 eligible GC/EGJ patients received T-mab combined chemotherapy between 2011 and 2018. The retrospective study analyzed 20 of the patients who underwent radical gastrectomy after chemotherapy, 7 of which were EGJ and 13 of which were GC; 11 were evaluated as initially inresectable and 9 were evaluated as resectable. Chemotherapy regimens included XP+T-mab (11 cases) and SOX+T-mab (9 cases), and the median period of preoperative chemotherapy was 3 cycles. During preoperative chemotherapy, 6 cases of grade 3/4 adverse reactions occurred, and no postoperative complications of grade ≥3b occurred. The three-year recurrence-free survival rate and overall survival rate were 58.9% and 89.5%, respectively.

study suggests that among HER-2-positive stage IV GC/EGJ patients, preoperative treatment of T-mab combined with chemotherapy, followed by active radical surgery, hopefully bringing more survival benefits to patients.

Title: Clinical Outcomes of Radical Gastrectomy Following Trastuzumab-Based Chemotherapy for Stage IV HER2-positive Gastric or Gastroesophageal Junction Cancer.

Journal: Surg Today(2.077). Pub Date: 2020 May 26.

Author: Ryo Takahashi, Souya Nunobe, Hiroki Osumi, et al.

Address: DOI: 10.1007/s00595-020-02011-9

[Is it necessary for elderly patients with GC to undergo standard D2 lymph node dissection? 】

D2 lymph node dissection is a standard surgery for advanced gastric cancer. With the intensification of aging, the number of elderly patients with gastric cancer is gradually increasing. This study evaluates whether D2 lymph node dissection is beneficial to elderly patients.

The investigators conducted a retrospective analysis of a multi-institutional database, including 3484 patients undergoing surgical resection of GC, and selected patients over 80 years old who were clinically diagnosed with T1N+ or T2-4, which were divided into D2 and non-D2 groups, with 87 patients in both groups. Use propensity scores to match balance key clinical features, including surgical type and staging.

results show that compared with the non-D2 group, the D2 group had significantly longer surgery time, greater blood loss, and higher lymph node detection rate (median value 32 vs 24, P <>

For older patients with GC, D2 lymph node dissection has little benefit to overall survival and increases the incidence of postoperative complications.

Title: D2 Lymph Node Dissection Confers Little Benefit on the Overall Survival of Older Patients With Resectable Gastric Cancer: A Propensity Score-Matching Analysis of a Multi-Institutional Dataset.

Journal: Surg Today(2.077). Pub Date: 2020 May 25.

Author: Takahiro Shinozuka, Mitsuro Kanda, Seiji Ito, et al.

Address: DOI: 10.1007/s00595-020-02021-7

[Young GC patients show stronger tumor aggressiveness and worse prognosis]

This study explores the clinical pathological characteristics and prognosis of young patients and elderly patients in gastric cancer. Patients with stage I-III gastric adenocarcinoma who underwent radical surgery were divided into the youth group (18-49 years old), middle-aged group (50-59 years old) and elderly group (≥60 years old). Exclusion criteria were history of neoadjuvant therapy and other malignant tumors. The clinical pathological characteristics of the three groups, overall survival (OS), disease-free survival (DFS), and recurrence were compared. The

study finally included 1131 patients, of which 270, 314 and 547 were in the youth group, middle-aged group and elderly group, respectively. The results showed that compared with the other two groups, the proportion of women, stage III disease, poor differentiation, N3b and receiving adjuvant chemotherapy accounted for a higher proportion in the youth group. The 5-year OS in the youth group was worse than that in the middle-aged group (62.4% vs 70.8%, P=0.019), but was better than in the elderly group (62.4% vs 58.7%, P=0.031). Compared with the middle-aged group, the 5-year DFS in the youth group was also poorer (75.2% vs 82.8%, P=0.040); and the incidence of peritoneal recurrence was higher than that in the middle-aged group (15.1% vs 5.2%, P<0.001),>

Young GC patients showed stronger tumor aggressiveness and had a poor prognosis compared with older patients, so this subgroup may need to strengthen management.

Title: Gastric Cancer in Young Patients: A Separate Entity With Aggressive Features and Poor Prognosis.

Journal: J Cancer Res Clin Oncol(3.332). Pub Date: 2020 May 25.

Author: Lyujia Cheng, Songyao Chen, Wenhui Wu, et al.

Address: DOI: 10.1007/s00432-020-03268-w

[Prognostic significance of tumor marker in patients with gastric cancer before and after surgery]

In clinical practice, carcinoembryonic antigen (CEA) and carcinoembryonic antigen (CA) 19-9 are the most commonly used tumor markers before and after gastric cancer surgery. However, it is not clear whether preoperative or postoperative tumor markers have greater prognostic value. The

study included patients undergoing gastric cancer resection into the testing group. The effects of preoperative and postoperative tumor markers on prognosis were analyzed using Kaplan-Meier method and multivariate COX regression, and the results were validated externally. There were 735 and 400 patients in the

detection and verification group, respectively. The more positive tumor markers were positive before and after surgery, the worse the overall survival rate (both were p <>

study suggests that the predictive value of preoperative tumor markers on postoperative prognosis in gastric cancer patients may be better than that after surgery, and the normal postoperative tumor markers are related to better long-term survival.

Title: Prognostic Significance of Pre- And Post-Operative Tumour Markers for Patients With Gastric Cancer.

Journal: Br J Cancer(5.416). Pub Date: 2020 May 26.

Author: Jun-Peng Lin, Jian-Xian Lin, Yu-Bin Ma, et al.

Address: DOI: 10.1038/s41416-020-0901-z