a Department of Medicine I (Hematology, Medical Oncology and Stem Cell Transplantation) , Medical Center - University of Freiburg , Freiburg , Germany.
b Comprehensive Cancer Center Freiburg (CCCF) , Medical Center - University of Freiburg , Freiburg , Germany.
Expert Rev Gastroenterol Hepatol. 2019 Apr;13(4):285-291. doi: 10.1080/17474124.2019.1573143. Epub 2019 Feb 4.
Platinum-based chemotherapy remains standard-of-care for gastric and gastroesophageal junction (GEJ) adenocarcinoma. For locally advanced resectable disease, perioperative treatment with cisplatin-based doublet or triplet chemotherapy regimens had been the predominant approach in Europe and the US, based on pivotal phase III trials including the MAGIC study. Results from more recent landmark studies including the German FLOT4 and the Asian CLASSIC trials have, however, triggered a shift from cisplatin towards oxaliplatin-based chemotherapy protocols in the perioperative setting. Areas covered: This drug profile summarizes current state-of-the-art of perioperative and adjuvant treatment for locally advanced resectable gastric/GEJ cancers with a special focus on the increasingly predominant role of oxaliplatin over cisplatin in this setting. We review pharmacology, clinical efficacy, and safety profile of oxaliplatin and oxaliplatin combination regimens. We highlight recent advances and ongoing developments in the field. Expert opinion: While the adoption of oxaliplatin-containing combination regimens for perioperative therapy of gastric/GEJ cancers represents a significant step ahead, many pivotal questions remain unanswered. At the sample time, the evolution of molecular subtyping and immunotherapy is likely to dramatically change clinical practice in the foreseeable future.
铂类化疗仍然是胃和胃食管交界处(GEJ)腺癌的标准治疗方法。对于局部可切除的疾病,基于包括 MAGIC 研究在内的关键 III 期试验,围手术期使用顺铂双联或三联化疗方案一直是欧洲和美国的主要方法。然而,来自最近的一些具有里程碑意义的研究,包括德国的 FLOT4 和亚洲的 CLASSIC 试验,促使围手术期治疗从顺铂转向奥沙利铂为基础的化疗方案。
本药物专题总结了局部可切除胃/GEJ 癌围手术期和辅助治疗的最新进展,特别强调了奥沙利铂在该治疗环境中对顺铂的作用日益突出。我们回顾了奥沙利铂及其联合方案的药理学、临床疗效和安全性特征。我们强调了该领域的最新进展和正在进行的发展。
虽然在胃/GEJ 癌的围手术期治疗中采用含奥沙利铂的联合方案是向前迈出的重要一步,但仍有许多关键问题尚未得到解答。在采样时,分子亚型和免疫治疗的发展可能会在可预见的未来极大地改变临床实践。