Gastric Cancer
Conditions
Brief summary
This single-center, open-label, randomized phase II trial (JAGC-1) will evaluate whether adjuvant chemotherapy can be safely omitted in patients with stage IB-III gastric cancer (cT2-4a and/or N+) who have achieved a pathological complete response (pCR) or TRG 4-5 on the Mandard scale, following neoadjuvant chemotherapy and surgery. The study aims to compare disease-free survival and quality of life in patients receiving or not receiving adjuvant chemotherapy after neoadjuvant treatment and surgery.
Detailed description
Population: patients with localized or locally advanced gastric cancer ( cT2-4a and/or N+ according to TNM, 8th revision, 2017) after having undergone the full extent of the planned neoadjuvant component of perioperative chemotherapy, radical surgical intervention, with a histological tumor regression grade classified as pCR or TRG 4-5 according to the Mandard scale Study design Patients will be randomized in a ratio of approximately 1:1: Patients who achieve pCR will be randomly assigned to one of two groups: * Group A (no adjuvant therapy): Patients will not receive adjuvant chemotherapy * Group B (adjuvant therapy): Patients will receive the adjuvant component of perioperative chemotherapy Patients who achieve a TRG of 4-5 on the Mandard scale will be randomly assigned to one of two groups: * Group C (adjuvant therapy): Patients will not receive adjuvant chemotherapy. * Group D (no adjuvant therapy): Patients will receive the adjuvant component of perioperative chemotherapy. Patients in the groups with adjuvant therapy will receive treatment until progression or maximal effect of therapy is detected (the longest duration of treatment is 3 months).
Interventions
OTHERSurveillance
Close monitoring for disease recurrence.
DRUGAdjuvant Chemotherapy
The adjuvant chemotherapy regimen will be standardized based on current clinical guidelines and may include combinations of agents such as fluoropyrimidines and oxaliplatin with or without docetaxel. Treatment until the progression of the process is detected or the maximum effect of therapy is achieved (the maximum duration of treatment is 3 months).
Sponsors
Nizhny Novgorod Regional Clinical Oncology Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* \- Obtaining informed consent to participate in the study. * Morphologically confirmed gastric adenocarcinoma. * The presence of localized or locally advanced gastric cancer (cT2-4a and/or N+) * The full volume of the planned neoadjuvant component of perioperative chemotherapy was performed * Radical surgical intervention was performed for the primary tumor of gastric cancer * The histological degree of tumor regression after surgical resection was classified TRG1 and without metastasis to regional lymph nodes N0 or TRG 4-5 based on the Mandard tumor Regression scale. * ECOG score 0 - I. * Absence of severe uncontrolled concomitant chronic and acute diseases. * Adequate liver and bone marrow function * Neutrophils \> 1.5\*109/l * Hemoglobin \>85 g/l * Platelets \>100\*109/l * Increased transaminases and/or bilirubin \< 2 art.
Exclusion criteria
* Lack of a neoadjuvant component of perioperative chemotherapy or insufficient number of courses * The time after surgical treatment is more than 12 weeks * Stage IV of the disease * Her2-positive and/or MSI\\dMMR stomach cancer * Severe uncontrolled concomitant chronic or acute diseases * The presence of a second malignant tumor (with the exception of previously cured malignant neoplasms) * Any conditions that, in the opinion of the doctor, interfere with the examination procedures * With incomplete tumor response to treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disease-free survival rates | 3 years | Comparison of 3-year DFS in the group receiving the adjuvant component of perioperative chemotherapy and in the group without it and comparison of the indicators of 3-year DFS with TRG 4-5 on the Mandard scale in the group receiving the adjuvant component of perioperative chemotherapy and in the group without it. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Аssessment of the quality of life | 3 years | Quality of life assessment by European Organisation for Research and Treatment of Cancer scale Quality of Life Questionnaire - Core 30 (QLQ-C30) by Scoring of the QLQ-C30 Summary Score using the descriptive analysis with the qlqc30 command (detailed description in manual ISBN 2-9300 64-22-6). |
Contacts
Primary ContactPetryakova Alex Julia, MD
Backup ContactMIKHAIL Anat OSIPOV, MD, PhD
Outcome results
None listed