Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond

Table 1 Completed and ongoing phase III trials of perioperative chemotherapy and chemoradiation in gastric cancer

	Timing, intervention	Treatment arms (n)	Results
INT0116[4]United States	Adjuvant, chemoradiation	Surgery alone (n = 275)	Median OS: 27 moHR = 1.35, 95%CI: 1.09-1.66 (P = 0.005)
		Surgery + 5-FU/LV/RT (n = 281)	Median OS: 36 mo
ARTIST[6]	Adjuvant, chemoradiation	Surgery (D2 resection) + capecitabine/cisplatin (n = 228)	3-yr DFS: 74.2%
South Korea		Surgery (D2 resection) + capecitabine/cisplatin/RT (n = 230)	3-yr DFS: 78.2%
			(P = 0.08)
ARTIST II[28]	Adjuvant, chemoradiation	Surgery (D2 resection, node-positive only) + capecitabine/cisplatin	In progress
South Korea		Surgery (D2 resection, node-positive only) + capecitabine/cisplatin/RT
ACTS-GC[9]	Adjuvant, chemotherapy	Surgery alone (D2 resection) (n = 30)	5-yr OS: 61.1%
Japan		Surgery (D2 resection) + oral S-1 postop (n = 529)	5-yr OS: 71.7HR = 0.67, 95%CI: 0.54-0.83
CLASSIC[8]	Adjuvant, chemotherapy	Surgery alone (D2 resection) (n = 515)	3-yr DFS: 59% (53%-64%)
South Korea		Surgery (D2 resection) + 8 cycles oral capecitabine + IV oxaliplatin (n = 520)	3-yr DFS: 74% (69%-79%)HR = 0.56, 95%CI: 0.44-0.72 (P < 0.0001)
MAGIC[10]	Perioperative, chemotherapy	Surgery alone (n = 253)	5-yr OS: 23%
United Kingdom		3 cycles ECF preop + surgery + 3 cycles ECF postop (n = 250)	5-yr OS: 36%HR = 0.75, 95%CI: 0.60-0.93 (P = 0.009)
FNCLCC/FFCD[11]	Perioperative, chemotherapy	Surgery alone (n = 111)	5-yr OS: 24%
France		5-FU/cisplatin preop + surgery + 5-FU/cisplatin postop (n = 113)	5-yr OS: 38%HR = 0.69, 95%CI: 0.50-0.95 (P = 0.02)
POET[15]	Neoadjuvant, chemoradiation	2.5 cycles PLF preop + surgery (n = 59)	3-yr OS: 27.7%
Germany		2 cycles PLF then PLF/RT preop + surgery (n = 60)	3-yr OS: 47.4%HR = 0.67, 95%CI: 0.41-1.07 (P = 0.07)
CRITICS[7]	Perioperative, combination	3 cycles ECX/EOX preop + surgery + capecitabine/cisplatin/RT postop	In progress
The Netherlands		3 cycles ECX/EOX preop + surgery + 3 cycles ECX/EOX postop
TOPGEAR[12]	Perioperative, combination	3 cycles ECF preop + surgery + 3 cycles ECF postop	In progress
Australia/New Zealand/Europe/Canada		2 cycles ECF with 5-FU/RT preop + surgery + 3 cycles ECF postop
Neo-AEGIS[13]	Perioperative, combination	3 cycles ECF preop + surgery + 3 cycles ECF postop	In progress
Ireland		Carboplatin/paclitaxel/RT preop + surgery
MAGIC-B[22]United Kingdom	Perioperative, chemotherapy	3 cycles ECX preop + surgery + 3 cycles ECX postop	In progress
		3 cycles ECX with lapatinib or bevacizumab preop + surgery + 3 cycles ECX with lapatinib or bevacizumab postop

OS: Overall survival; DFS: Disease-free survival; 5-FU: 5-Fluorouracil; LV: Leucovorin; RT: Radiotherapy; ECF: Epirubicin/cisplatin/5-FU; PLF: Cisplatin/fluorouracil/leucovorin; ECX: Epirubicin/cisplatin/capecitabine; EOX: Epirubicin/oxaliplatin/capecitabine.