The National Comprehensive Cancer Network (NCCN) published the first edition of its 2015 clinical practice guidelines for gastric cancer on Jan. 8, 2015. Medical Pulse has compiled the Multidisciplinary Team Management Principles, Systemic Treatment Principles and Protocols section of the guidelines for the benefit of readers.
Principles of multidisciplinary team management for patients with gastroesophageal cancer
Systemic treatment principles
● The recommended systemic treatment protocols for advanced adenocarcinoma of the esophagus and gastroesophageal junction (EGJ), esophageal squamous cell carcinoma, and gastric adenocarcinoma can be interchanged
● For metastatic adenocarcinoma, trastuzumab can be added to chemotherapy if the tumor is HER2-neu overexpressed.
● For patients with advanced disease, a combination regimen of two cytotoxic agents with lower toxicity is recommended. A combination regimen of three cytotoxic agents may be considered for medically healthy
PS well patients and require frequent toxicity assessment.
● Modification of the Tier 1 regimen, or use of the 2A or 2B regimens, is recommended, with evidence of more favorable toxicity and no reduction in efficacy.
Intravenous infusion of fluorouracil and capecitabine can be interchanged with no reduction in efficacy (exclusions as noted) The recommended route of administration is intravenous infusion compared with intravenous regimens of fluorouracil.
Cisplatin and oxaliplatin can be interchanged, depending on toxicity.
● Peri-operative chemotherapy or post-operative chemotherapy plus radiotherapy is recommended for localized gastric cancer.
● Postoperative chemotherapy is recommended for use after D2 lymph node dissection (see Principles of Surgery).
● Induction chemotherapy can be used if clinically indicated.
● Under adjuvant conditions, patients should be monitored for long-term treatment-related complications after completion of chemotherapy.
Preoperative chemotherapy
● Intravenous infusion of 5-FU can be replaced with capecitabine
● Recommended regimen.
Paclitaxel and carboplatin
Cisplatin and fluorouracil
Oxaliplatin and fluorouracil
● Other regimens
Irinotecan and cisplatin (category 2B)
Paclitaxel and fluoropyrimidine (fluorouracil or capecitabine) (category 2B)
Perioperative chemotherapy (3 cycles before surgery, 3 cycles after surgery)
● ECF (epirubicin, cisplatin, and fluorouracil) (category 1)
● ECF modified regimen
Epirubicin, oxaliplatin, and fluorouracil
Epirubicin, cisplatin and capecitabine
Epirubicin, oxaliplatin, and capecitabine
● Fluorouracil and cisplatin (category 1)
Postoperative radiotherapy
Fluorouracil treatment (intravenous fluorouracil or capecitabine) before and after fluorouracil-based radiotherapy
Postoperative chemotherapy (for patients who have undergone D2 lymph node dissection)
● Capecitabine and oxaliplatin
● Capecitabine and cisplatin