Recent trends in adjuvant therapy for gastric cancer.

I.F. 0.545 Abstract: Therapeutic control of gastric carcinoma is still unsatisfactory in western countries despite the progress made in surgical techniques and intensive care. Adjuvant therapy aims at improving the results obtained with surgery alone. We present a review of controlled clinical trials on adjuvant chemotherapy and chemoimmunotherapy for gastric cancer and make an appraisal in the light of our experience and of the gastrointestinal group of the EORTC. So far, no statistically significant improvement in survival has been demonstrated in controlled trials conducted in Europe and USA, nor has the efficacy of the FAM regimen in advanced gastric cancer been confirmed in an adjuvant setting. The results of adjuvant therapy appear more satisfactory in Japan than in western countries. This may be partly due to the fact that in Japanese studies chemotherapy is started intraoperatively or during the immediate postoperative period. Other factors may also be the impact of early diagnosis made through mass screening and the standardized surgery in Japan. The new therapeutic trends, using recently available chemotherapeutic compounds tested in Phase II clinical trials or by combining traditional chemotherapy with different types of immunostimulators, are discussed. Their therapeutic efficacy in the adjuvant setting can only be confirmed if large-scale Phase III trials are performed.