Berenato R, et al. – The safety and activity of capecitabine, oxaliplatin, and irinotecan (COI regimen) were assessed as a preoperative treatment for resectable gastric cancer (GC) or gastroesophageal junction (GEJ) cancer. In patients with resectable GC or GEJ cancer, COI combination was active with a manageable toxicity profile. In addition, fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging as a surrogate biomarker of pathological response in this setting appeared fascinating. However, it required further investigation.

Methods

• The COI regimen for 4 cycles followed by restaging and gastroresection with D2 lymphadenectomy was used to treat patients affected by T3-T4/N0-N+/M0 GC/GEJ cancer.
• The clinicians scheduled four postoperative cycles.
• According to Becker et al. [Cancer 2003;98:1521-1530], the primary endpoint was pathological response rate.
• They appraised the potential role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as a predictive biomarker of pathological tumor response in a subgroup of 19 evaluable patients. 

Results

• 40 patients were enrolled, between January 2011 and October 2015.
• In addition, after the preoperative phase, 36 out of 40 patients (90%) were considered eligible for surgery: 12 patients (30%) achieved a pathological response.
• Diarrhea (27%), nausea (25%), and fatigue (17%) were the most frequent grade 3/4 adverse events.
• This study noticed grade 3 neutropenia in 7.5% of patients.
• A link was observed between a lower standard uptake value at baseline FDG-PET/CT and pathological response.