Practical management of oligometastatic gastric cancer

Gastric cancer is one of the types of cancer with a high prevalence of morbidity. The frequency of esophagogastric junction cancer, 5-year survival rates, perioperative adjuvant therapy, and standard chemotherapeutic regimens for gastric cancer vary between Asian countries and the West. Although oligometastasis is considered an intermediate state between localized and systemic disease, no standardized definition regarding metastatic organ sites or international consensus in gastric cancer exists. Both local treatment, such as radical surgery and radiotherapy, and systemic chemotherapy can be employed for treating patients with gastric cancer with oligometastatic disease. Recently, evidence for oligometastatic gastric cancer has been accumulated, including findings from several clinical trials conducted in Asian and Western countries, focusing on both organ-specific and non-organ-specific oligometastatic gastric cancer. Here, we review the latest findings on oligometastasis in gastric cancer, including variations in treatment strategies between Western and Asian countries. Further investigation is needed to determine the most favorable practical management strategies for patients with metachronous oligometastasis in gastric cancer, including the use of molecular-targeted agents and immune checkpoint inhibitors. The results of ongoing trials may shed light on the optimal treatment approaches for oligometastatic disease

Neutropenia as a prognostic factor in metastatic colorectal cancer patients undergoing chemotherapy with first-line FOLFOX

4115 Background: FOLFOX combined with bevacizumab is established as standard first-line chemotherapy for metastatic colorectal cancer (MCRC), and neutropenia is one of the most common of its side effects. Neutropenia during chemotherapy has been reported to be a predictor of better survival in patients with several type of cancers, although there are no reports in MCRC. We aimed to assess whether neutropenia during chemotherapy could be a marker of improved survival of patients with MCRC. Methods: Patients with MCRC who received FOLFOX with or without bevacizumab as first-line chemotherapy were retrospectively analyzed to assess whether neutropenia during chemotherapy is associated with improved survival. Several background characteristics and chemotherapy features (grade of neutropenia, use of bevacizumab, use of irinotecan, reintroduction of oxaliplatin, and tumor progression) as time-varying covariates (TVCs) were analyzed as potential prognostic factors. Results: Of 153 patients, mild neutropenia (grade 1–2) occurred in 60 patients (39%) and severe neutropenia (grade 3–4) occurred in 46 patients (30%). The other 47 patients (31%) did not experience neutropenia. In 106 patients experiencing neutropenia, 66% of patients experienced their highest grade within 4 cycles. According to a multivariate Cox model with TVCs, hazard ratios of death were 0.55 (95% CI, 0.31–0.98; P = 0.044) for patients with mild neutropenia and 0.35 (95% CI, 0.18–0.66; P = 0.002) for those with severe neutropenia. If the analysis of neutropenia was limited to 4 cycles of FOLFOX, mild or severe neutropenia remained a significant prognostic factor according to survival analysis with TVCs. Conclusions: Both mild and severe neutropenia during chemotherapy are associated with improved survival in patients with MCRC. Prospective trials are required to assess whether dosing adjustments based on neutropenia may improve chemotherapy efficacy. No significant financial relationships to disclose. </jats:p