Abhishek Mitra

Neoadjuvant chemotherapy in patients with locally advanced gallbladder cancer

AIM Surgery is the only curative option for patients with gallbladder cancer (GBC). This study looks at the outcome of patients treated with neoadjuvant chemotherapy (NACT). PATIENTS & METHODS This is retrospective analysis of the prospectively maintained database of patients with locally advanced GBC treated between February 2009 and September 2013 with NACT. Patients received gemcitabine-platinum based regimen. RESULTS A total of 37 patients (median age: 54 years, 64.9% females) received NACT. Overall response rate was 67.5%. In total, 17 patients (46%) underwent R0 resection. Median overall survival/progression-free survival of the whole group was 13.4/8.1 months, respectively. Patients who underwent surgery had a significantly better overall survival (median not reached vs 9.5 months) and progression-free survival (25.8 vs 5.6 months), respectively. CONCLUSION NACT increases resectability and survival in patients with locally advanced GBC.

Histopathological regression after taxane based neoadjuvant chemotherapy in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma

We read with great interest the phase 2 randomized trial FLOT4-AIO. Al-Batran et al . have published the results of the phase 2 part of this phase 2/3 randomized controlled trial (RCT). They have compared FLOT (Docetaxel, Oxaliplatin, 5FU and leucovorin) regimen to the standard neoadjuvant regimen [ECX/epirubicin, cisplatin and 5-flourouracil (ECF)] (1). The primary end point for this trial was tumour regression grade (TRG1a as per Becker’s criteria) of primary tumor. All age group of patients with non-metastatic gastric and esophagogastric junction adenocarcinoma (GaCaGEJ), > cT2 and/or N+ve, were included and patients with adjacent organ invasion were excluded. The groups compared included 137 patients in ECX/ECF vs. 128 in FLOT group in a modified intention to treat analysis. The significant findings included an improved resectability rate, favorable pT stage and R0 resection rate with the use of FLOT. FLOT also resulted in an improved overall TRG1a and TRG1a + 1b and an improved TRG1a + 1b in the intestinal histology, without any increase in perioperative outcomes and non-surgical adverse events (1)