Perioperative Therapie des Adenokarzinom des Magens und des gastroösophagealen Übergangs – aktuelle Entwicklungen

Background: Adenocarcinomas of the stomach and gastroesophageal junction (GEJ) are often diagnosed in advanced metastatic stages, meaning that treatment with a curative intent is only possible in less than one third of patients. Current national and international guidelines recommend perioperative chemotherapy according to the fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) regimen for the treatment of locally advanced adenocarcinoma of the stomach and GEJ (≥ T2 and/or N + tumors) or for tumors of the GEJ, neoadjuvant radiotherapy according to the carboplatin/paclitaxel plus 41.4Gy irradiation (CROSS) regimen. Objective: Presentation of the current guideline-compliant therapy and classification of the latest developments in the perioperative therapy of adenocarcinoma of the stomach and GEJ. Methods: Literature search in the PubMed database, ClinicalTrials.gov and current guidelines. Results and discussion: The current results of the German phase III ESOPEC study show for the first time a clear advantage of perioperative chemotherapy with FLOT compared to neoadjuvant chemoradiotherapy according to CROSS for locally advanced adenocarcinoma of the GEJ. Phase III studies on the implementation of immunotherapy (MATTERHORN, KEYNOTE-585, DANTE) and other targeted therapies, such as HER2 antibodies (HERFLOT, PETRACA, INNOVATION) in perioperative concepts show promising improvements with respect to pathological complete remission; however the influence on long-term survival is still unclear. Data on neoadjuvant immunotherapy in the selected patient collective with microsatellite instability (MSI-high/dMMR) indicate that neoadjuvant/definitive immunotherapy could possibly replace perioperative chemotherapy for these tumors. Whether surgery can be dispensed with in this molecularly defined subgroup in the future, must be evaluated in studies.