Resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma — AGITG (Australasian Gastro-Intestinal Trials Group) with EORTC, TROG, CCTG intergroup
Visit Interactive Trial Page →
Top tweets by impressions — click to view on X
Yes, I made a similar pt in my talk re: TOPGEAR. Differences in treatment effect by primary tumor location. https://t.co/oJOCCH4vzf https://t.co/8cICuiK0aO
@RyanMorseKU @nbn426 @KristenCiombor @NiuSanford The fascinating thing from TOPGEAR = primary tumor site location. Gastric benefits more from chemo, w/important treatment x primary tumor site…
What an amazing session by @NiuSanford and Dr. Sanjay Wani! #GI25 Great discussion on ESOPEC, TOPGEAR and other trials and breakdown of current practice guidelines! Insightful @AnwaarSaeed3…
Trevor Leong, MBBS, MD, FRANZCR, discusses findings from the TOPGEAR trial assessing perioperative chemoradiotherapy in gastric/GEJ cancer. @PeterMacCC @myESMO #ESMO24 #oncology…
7/10 – TOPGEAR #ESOsm #STCsm
Phase 3 - periop CTx with or without preop CRT for resectable gastric cancer
#ESMO24 @myESMO @NEJM @GICancer @CDNCancerTrials
N= 574 pts
👉 33% FLOT
👉pCR 167vs 78%
👉PFS…
TOPGEAR is the definitive Phase 3 answer to whether preoperative chemoradiation improves outcomes over perioperative chemotherapy alone in resectable gastric/GEJ adenocarcinoma. Despite more than doubling pCR (17% vs. 8%) and more tumor/node downstaging, the addition of 45 Gy preoperative CRT did NOT improve OS (46 vs. 49 months) or PFS (31 vs. 32 months). Along with ESOPEC (FLOT > CROSS in esophageal adenocarcinoma), TOPGEAR consolidates perioperative chemotherapy (FLOT) as SOC globally. Role of radiation in this setting is retreating; future direction focuses on improving systemic regimens with immunotherapy (MATTERHORN perioperative durvalumab + FLOT) and targeted agents.
Median: 46 months (preop CRT + perioperative chemo (Arm B)) vs. 49 months (perioperative chemo alone (Arm A, ECF or FLOT)). HR 1.05 (95% CI 0.83-1.31) 5-year OS rate rate: 45% (CRT + chemo) vs. 45% (chemo alone). Phase 3 intergroup trial enrolled N=574 (Arm A chemo alone 288, Arm B CRT + chemo 286). Tumor location: 35% at GEJ; Stage: 88% T3, 60% node-positive. Median follow-up 67 months. Median OS 46 months (CRT) vs. 49 months (chemo alone) — HR 1.05 (95% CI 0.83-1.31) — NOT significantly different. 5-year OS ~45% in both groups. Median PFS 31 vs. 32 months. Primary endpoint NOT MET. Leong et al., NEJM 2024.
HR 1.05 (95% CI 0.83-1.31) OS was the primary endpoint (see above). Despite pCR improvement with CRT (17% vs. 8%), no OS difference. Investigators concluded preoperative CRT should NOT become routine SOC. Consolidates perioperative chemotherapy (FLOT, per ESOPEC for esophageal; FLOT4 for gastric) as SOC.
Both arms well-tolerated and feasible. Addition of CRT did not increase treatment-related toxicity or surgical risks. Compliance 95% RT, 91% chemo. Surgery performed 84% (CRT) vs. 89% (chemo alone). R0 resection 92% in both. pCR 17% vs. 8% (significantly better with CRT) but no OS translation. Toxicity: similar across groups, no major increase in surgical or GI/hematologic toxicities.
❌ Negative Phase 3: Preoperative CRT adds no OS benefit to perioperative chemo in resectable gastric/GEJ cancer. TOPGEAR is the definitive Phase 3 answer to whether preoperative chemoradiation improves outcomes over perioperative chemotherapy alone in resectable gastric/GEJ adenocarcinoma. Despite more than doubling pCR (17% vs. 8%) and more tumor/node downstaging, the addition of 45 Gy preoperative CRT did NOT improve OS (46 vs. 49 months) or PFS (31 vs. 32 months). Along with ESOPEC (FLOT > CROSS in esophageal adenocarcinoma), TOPGEAR consolidates perioperative chemotherapy (FLOT) as SOC globally. Role of radiation in this setting is retreating; future direction focuses on improving systemic regimens with immunotherapy (MATTERHORN perioperative durvalumab + FLOT) and targeted agents.
