ESMO GI 2025 | Perioperative treatment in advanced gastric and GEJ cancer

So in this session I will also discuss about the perioperative treatment for locally advanced gastric and GE junction cancers. Actually there is a different strategy in each region. For example, Western countries or non-Asian countries or doctors apply perioperative chemotherapy to achieve increased R0 resection and downstage tumor. In contrast, in Asia upfront surgery is more preferred approach until recently because of the well-established surgical technique and previous study to establish as one treatment. So there is a difference. But recently we have also perioperative data from Asian group. One study is from Korea which triplet regimen improved PFS and OS compared with adjuvant surgery. And other Chinese trials also show the perioperative doublet chemotherapy improved PFS and OS in gastric cancer population. So I believe standard care is gradually getting similar. And now we have a checkpoint inhibitor trial. Previous trial like ATTRACTION-5 in adjuvant setting in AGC and Keynote 585 trial to combine doublet chemo and Pembrolizumab unfortunately didn’t show significant long-term benefit. But recent Matterhorn study presented at ASCO showed a significant EFS event-free survival improvement with a combination with FLOT plus Durvalumab compared with FLOT plus placebo. And this must be the first randomized global study to establish one of the best operative treatment for our patients with gastric adenocarcinoma cancer. Safety results are very similar to that we observed in metastasis population. And very interestingly, subgroup analysis didn’t show large difference according to biomarker status like PD-L1, CPS, or TPS status. So I believe such data will be submitted to regulatory authority very soon and we are waiting for the results. And after that, we need to consider future steps. And there should be some remaining clinical questions, for example, component contribution of adjuvant phase and how to define the patient who exactly need additional treatment to improve our outcome. And even with FLOT plus Durvalumab as the best current treatment, still not a few patients eventually experience disease recurrence progression. So to combine it with other agents which is already used in metastatic setting is also attractive. For example, HER2-targeted therapy, VEGF-targeted therapy, and recent press release indicate OS improvement by FGFR-2B-targeted therapy. So I hope this new treatment may further improve the outcome of locally advanced gastric cancer population. And lastly, this is just the beginning of global collaboration. In Metastatic study, we have a kind of collaboration to show the benefit of new agents. But as mentioned before, there is a kind of difference of standard care in each region for locally advanced population. But after our Matterhorn study, which established the best global standard care, I believe we could have a more global collaboration to establish future standards for locally advanced population. So I believe the future is bright for research.

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