Gastric cancer

Gastric cancer

Gastric Cancer

Which histologies were allowed in the FLOT4-AIO trial ?

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Adenocarcinoma

Gastric Cancer
Gastric Cancer

Was there a difference in the number of cycle of chemo between the 2 arms in the FLOT-AIO trials ?

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Yes, 3 pre- and post-op with ECF/ECX versus 4 pre- and post-op with FLOT

Gastric Cancer
Gastric Cancer

Were lymph node positive patient allowed in the FLOR4-AIO trial ?

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Yes

Gastric Cancer
Gastric Cancer

What did the FLOT4-AIO trial assess for gastric cancer ?

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Perioperative chemotherapy with 5-FU/Lv, oxaliplatin, docetaxel vs 5-FU/Lv or capecitabine , cisplatin , epirubicin for locally advanced and resectable gastric / GEJ adenocarcinoma

Gastric Cancer
Gastric Cancer

Was there an improvement in survival seen in the CLASSIC trial for gastric cancer ?

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Yes, very statistically significant 5-year OS

Gastric Cancer
Gastric Cancer

What type of surgery was offered in the CLASSIC trial for gastric cancer ?

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D2

Gastric Cancer
Gastric Cancer

What did the CLASSIC trial assess in gastric cancer ?

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Adjuvant capecitabine plus oxaliplatin versus observation after Dastrectomy

Gastric Cancer
Gastric Cancer

What was difference in chemo regimens for the CRITICS versus MAGIC trial for gastric cancer ?

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MAGIC – ECF while CRITICS – either cisplatin or oxaliplatin and capecitabine (not 5-FU)

Gastric Cancer
Gastric Cancer

Which geographic regions did the CRITICS trial draw patients from for gastric cancer ?

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Europe and the United States, no Asian countries

Gastric Cancer
Gastric Cancer

Which regimen was used in the MAGIC trial in gastric cancer ?

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ECF

Gastric Cancer
Gastric Cancer

What did the MAGIC trial assess in gastric cancer ?

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Neo-adjuvant and adjuvant versus surgery alone for locally advanced gastric cancer

Gastric Cancer
Gastric Cancer

What did the CRITICS trial assess for locally advanced gastric cancer ?

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The addition of post-operative chemoradiotherapy to patients that had received neoadjuvant chemo versus perioperative chemotherapy

Gastric Cancer
Gastric Cancer

What did the TAX-325 trial assess in metastatic gastric cancer ?

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Improvement in OS with the addition of docetaxel to 5-FU/Cisplatin

Gastric Cancer
Gastric Cancer

What did the V-325 trial assess for metastatic gastric cancer ?

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Improvement in ORR with the addition of 5-FU to docetaxel/cisplatin

Gastric Cancer
Gastric Cancer

What did the JACOB trial assess ?

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The addition of pertuzumab or placebo to trastuzumab/chemo in first-line metastatic gastric cancer. There was no improvement in overall survival

Gastric Cancer
Gastric Cancer

What did the HELOISE trial assess in gastric cancer ?

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Failure to demonstrate an improvement in overall survival with higher dose trastuzumab 10 mg/m² versus 6 mg/m² plus platinum based chemotherapy and advanced gastric cancer

Gastric Cancer
Gastric Cancer

What did the ToGA trial assess in gastric cancer ?

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Phase 3 trial demonstrating an improvement in overall survival for the addition of trastuzumab to platinum-based chemotherapy

Gastric Cancer
Gastric Cancer

Which phase 3 trial assess the efficacy of bevacizumab in advanced gastric cancer ?

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None

Gastric Cancer
Gastric Cancer

What did the COUGAR-2 trial assess the metastatic gastric cancer ?

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Single agent docetaxel versus best supportive care, showed statistically significant improvement in overall survival

Gastric Cancer
Gastric Cancer

What did the ATTRACTION-2 trial assess in gastric cancer ?

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Statistically significant improvement in overall survival with nivolumab in metastatic gastric cancer progressing on 2 lines of therapy

Gastric Cancer
Gastric Cancer

Is there are non-inferiority date for weekly nab-paclitaxel versus paclitaxel for advanced gastric cancer ?

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Yes, ABSOLUTE trial

Gastric Cancer
Gastric Cancer

Was there a statistically significant improvement in overall survival in the RAINBOW trial in gastric cancer ?

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Yes

Gastric Cancer
Gastric Cancer

With did the RAINBOW trial assess in metastatic gastric cancer ?

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Ramucirumab plus paclitaxel versus paclitaxel as second line therapy following treatment with at least a fluoropyrimide and a platinum agent

Gastric Cancer
Gastric Cancer

What was pembrolizumab compared to in the KEYNOTE-061 trial for advanced gastric cancer ?

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Paclitaxel

Gastric Cancer
Gastric Cancer

What was the dosing and frequency of regorafenib in the INTEGRATE trial for gastric cancer ?

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160mg daily x 21 days on a 28 day cycle

Gastric Cancer
Gastric Cancer

What did the INTEGRATE trial assess in metastatic gastric cancer ?

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Regorafenib

Gastric Cancer
Gastric Cancer

Did TAGS demonstrate improved overall survival in gastric cancer ?

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Yes

Gastric Cancer
Gastric Cancer

What did the TAGS trial assess in metastatic gastric cancer ?

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TAS-102 in heavily pretreated metastatic gastric cancer

Gastric Cancer
Gastric Cancer

Is there a survival advantage to trastuzumab beyond progression in metastatic gastric adenocarcinoma ?

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No

Gastric Cancer
Gastric Cancer

What did the CLASSIC trial assess in gastric cancer ?

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The addition of capecitabine/oxaliplatin in the adjuvant setting following D2 gastrectomy in stage II/III gastric cancer

Gastric Cancer
Gastric Cancer

What did the CRITICS trial assess in gastric cancer ?

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Capecitabine instead of 5-FU plus epirubicin/cisplatin or epirubicin/oxaliplatin

Gastric Cancer
Gastric Cancer

Which agents were used in the MAGIC trial ?

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Epirubicin, cisplatin, 5-FU

Gastric Cancer
Gastric Cancer

Which taxane is used in the FLOT regimen for gastric cancer ?

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Docetaxel

Gastric Cancer
Gastric cancer

Which gastric cancer patients can go straight to chemoradiotherapy?

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Gastric cardia only, treat as GEJ – hence CROSS trial

Gastric cancer
Gastric cancer

Is there meta-analysis level data showing a benefit of neoadjuvant treatment for gastric cancer?

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Yes, for both overall survival and progression free survival

Gastric cancer
Gastric cancer

If there are any randomized data comparing neoadjuvant versus adjuvant treatment for gastric cancer?

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No

Gastric cancer
Gastric cancer

What are the 4 important trials for gastric cancer?

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MAGIC – assess the role perioperative chemotherapy
ARTIST – assess the role of adjuvant radiotherapy
CLASSIC – assess the role of adjuvant chemotherapy
CRITICS – assess the role of neoadjuvant chemotherapy followed by adjuvant chemoradiotherapy

Gastric cancer
Gastric cancer

What was the purpose of the CLASSIC clinical trial in gastric cancer?

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After a D2 gastrectomy, patients randomized to observation versus adjuvant XELOX for 8 cycles –
showed a 3 year overall survival of 59% versus 74%

Gastric cancer
Gastric cancer

What is the primary difference between adjuvant gastric cancer therapy in the United States versus
Japan?

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Japan – S1 chemotherapy for 1 year in the adjuvant setting
United States – concurrent chemoradiotherapy in the adjuvant setting

Gastric cancer
Gastric cancer

What did the ARTIST clinical trial show for gastric cancer?

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Cisplatin + capecitabine + radiotherapy versus chemotherapy alone in the adjuvant setting with possible
improved overall survival for lymph node positive patients who had undergone D2 resection

Gastric cancer
Gastric cancer

Which chemotherapy regimen was used in the MAGIC clinical trial?

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Epirubicin day 1 and 21, cis-platinum day 1 and 21, continuous 5-fluorouracil 6 weeks

Gastric cancer
Gastric cancer

What is the association of Her2 and radiotherapy for gastric cancer?

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High IHC staining is associated with poor radiotherapy response.

Gastric cancer
Gastric cancer

How can you manage gastric cancer patients who have already undergone curative resection with
adequate lymph node dissection?

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5 fluorouracil plus leucovorin followed by concurrent 5-fluorouracil and radiotherapy followed by 5-FU
leucovorin (or) substitute 5-fluorouracil for capecitabine

Gastric cancer
Gastric cancer

What T stage can spare a neoadjuvant approach for gastric cancer?

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T1 only
T2, T3, T4 lesions require chemotherapy and radiotherapy approach

Gastric cancer
Gastric cancer

What defines N1, N2, and N3 for gastric cancer?

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N1 = 1-2 lymph nodes
N2 = 3-6 lymph nodes
N3 = >/= 7 lymph nodes

Gastric cancer
Gastric cancer

What defines T1, T2, T3, T4 gastric cancer?

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T1–mucosa, submucosa, lamina propria invasion
T2–muscularis invasion
T3 connective tissue invasion
T4 viscera and adjacent structure invasion

Gastric cancer
Gastric cancer

What are the 2 options for Tis or T1a, T1b, T2 gastric cancer?

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T1a= endoscopic resection or surgery
T1b= surgery
T2= same as all gastric cancer

Gastric cancer
Gastric cancer

What options do gastric resection candidates who have bulky disease have in the preoperative setting?

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Concurrent chemoradiotherapy

Gastric cancer
Esophageal cancer

How can you locally manage Tis of the distal esophagus?

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RFA

Esophageal cancer
Esophageal cancer

How can you manage R1 resection if there is or isn’t preoperative chemoradiotherapy given?

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If no preoperative chemoradiotherapy then give adjuvant chemoradiotherapy
If preoperative chemoradiotherapy already given – case by case

Esophageal cancer
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