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Radiation did not increase toxicity when used with capecitabine and cisplatin

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2009 Gastrointestinal Cancers Symposium

Radiation in conjunction with capecitabine and cisplatin was as safe as capecitabine and cisplatin alone for patients with resected gastric cancer with D2 nodal dissection, according to the safety results of the phase-3 ARTIST trial.

Jeeyun Lee, MD, PhD, a clinical assistant professor at Samsung Medical Center in Seoul, discussed the ARTIST trial at the 2009 Gastrointestinal Cancers Symposium in San Francisco.

The researchers randomly assigned 228 patients to capecitabine (Xeloda, Roche) and cisplatin alone and 230 patients to chemotherapy plus radiation. Two deaths were associated with treatment.

Almost 91% of patients in both arms experienced neutropenia, but Lee said few patients experienced severe neutropenia.

“Radiation therapy did not add toxicity to chemotherapy and the capecitabine/cisplatin regimen was tolerable in a postoperative setting,” she told HemOnc Today. Grade-3/grade-4 neutropenia was observed in 2.5% of all cycles in both arms.

Similarly, 72.5% of patients in both arms experienced anemia, but only 0.46% in the chemotherapy arm and 0.2% in the chemotherapy plus radiation arm experienced severe toxicity.

Lee added that 82% of patients in the radiation plus chemotherapy arm completed treatment compared with 75% in the capecitabine/cisplatin alone arm. Disease-free survival results are expected by 2011. – by Jason Harris

The preliminary results of ARTIST have already provoked discussion regarding the safety and feasibility of adjuvant chemoradiation compared with chemotherapy alone after D2 gastrectomy. Is postoperative chemotherapy a better approach in the treatment of D2–resected gastric cancer? This debate will only be resolved when the disease control outcome data of the ARTIST study are available. It is unclear how and if the results of the Asian trials can be applied to the United States given significant differences in oncologist experience and patient populations compared with Asia.

– Gary Y. Yang, MD

Associate Professor of Radiation Oncology
Roswell Park Cancer Institute, Buffalo, N.Y.

For more information:

• Lee J. #5. Presented at: 2009 Gastrointestinal Cancers Symposium; Jan. 15-17, 2009; San Francisco.