An update of adjuvant treatments for localized advanced gastric cancer

Although adjuvant therapy has become the standard of care worldwide for resectable localized gastric cancer, geographic differences exist in standard adjuvant treatments: postoperative chemoradiation in North America, perioperative chemotherapy in Europe, and postoperative chemotherapy in East Asia. Global differences in standard surgical methods or study populations may influence the discrepancies in adjuvant therapy. However, now that D2 gastrectomy has been recognized as the optimal surgery for localized gastric cancer in the West, the standard adjuvant treatments used may need to be reconsidered. One of the most pertinent issues surrounding adjuvant therapy is how to improve the outcomes of current standard treatments. Negative results of recent Phase III trials suggest that simply intensifying the adjuvant chemotherapy is insufficient to enhance its efficacy in patients with localized gastric cancer. However, the AMC 0101 study showed that new strategies, such as the early initiation of chemotherapy and/or intraperitoneal chemotherapy, may further improve the efficacy of current standard adjuvant therapy.