TAS-118 plus oxaliplatin in advanced gastric cancer: is it worth it?
Mené au Japon et en Corée sur 711 patients atteints d'un cancer de l'estomac de stade avancé, cet essai de phase III compare l'efficacité, du point de vue de la survie globale, et la toxicité de deux stratégies thérapeutiques de première ligne à base de S-1, l'une combinée avec la leucovorine et l'oxaliplatine, l'autre combinée avec le cisplatine
Gastric cancer is the fifth most common malignancy worldwide, accounting for nearly 1 million new cases and an estimated 782 000 deaths in 2018, two thirds of which were in eastern Asia. Until recently, natural history and management of gastric cancer differed between Asian countries and Europe and North America in many aspects. Patients in eastern Asia were diagnosed at a younger age than those in Europe and North America, with tumours which were less advanced and more likely to be of distal location and of intestinal histology according to Lauren's classification. Also, Asian physicians were more likely than those in Europe and North America to perform radical surgery and to use adjuvant chemotherapy rather than perioperative chemotherapy for localised disease. However, practices are changing over time, and geographical differences in the treatment of localised and metastatic gastric cancer are becoming increasingly less pronounced, even though some medications are not available or are not reimbursed equally in all countries. Globally, doublet or triplet chemotherapy regimens with a platinum-fluoropyrimidine backbone are the preferred first-line treatment for fit patients with HER2-negative gastric cancer. Regarding the use of fluoropyrimidines, capecitabine or S-1 can be used as an alternative to infusional fluorouracil in doublet regimens. In addition, cisplatin or oxaliplatin are viewed as platinum agents with similar effectiveness when incorporated in doublet or triplet regimens, although this aspect remains a matter of debate. S-1 plus cisplatin has been widely used in eastern Asia, whereas infusional fluorouracil (plus leucovorin) or capecitabine, combined with oxaliplatin or cisplatin, are standard practices in Europe and North America.
The Lancet Oncology , commentaire, 2019