Marcel Verheij, radiation-oncologist, Radboud University, Nijmegen, The Netherlands
Biography
Marcel Verheij is chair of the department of Radiation Oncology of the Radboud University Medical Center in Nijmegen and professor of Radiotherapy at the Radboud University. As a group leader at Radboudumc, he chairs the research program Non-/Minimally Invasive Cancer Treatment, which aims to develop, implement and evaluate innovative treatment modalities in the clinic. He has a clinical interest in upper gastro-intestinal malignancies and coordinated several clinical trials in esophago-gastric cancer (e.g., CRITICS and CRITICS-II studies). His translational research is positioned at the interface between lab and clinic and focuses on targeted radiosensitization by modulating molecular determinants of tumor and normal cell radiosensitivity.
www.linkedin.com/in/marcel-verheij-a90b238/
Summary of presentation
Although its incidence is declining in most countries, gastric cancer remains a major cause of cancer-related mortality worldwide. Prognosis shows strong geographic variation, but remains poor as most patients present with advanced stages of the disease. Surgery is the cornerstone of cure in these patients, but the rate of locoregional recurrences are high. To improve outcome, the treatment of locally advanced gastric adenocarcinoma has evolved from a predominantly surgical to a multidisciplinary approach, combining optimal locoregional and systemic therapies. Post-operative chemoradiotherapy, peri-operative chemotherapy and post-operative chemotherapy are evidence-based strategies that increase survival rates as compared to surgery-only.
In Western patient populations post-operative chemoradiotherapy and perioperative chemotherapy have shown to improve survival as compared to surgery-alone. Direct comparison of perioperative chemotherapy with pre-operative chemotherapy and post-operative chemoradiotherapy in the CRITICS randomized phase III trial resulted in equivalent outcome.
Most adjuvant studies, however, suffer from poor patient compliance, especially in the postoperative phase. Due to toxicity and disease progression, only 40-60% of patients are able to complete the full treatment as planned. Preoperative treatment is associated with increased patient protocol adherence compared to postoperative therapies. Preoperative chemoradiotherapy represents a promising strategy to induce downstaging and improve surgical radicality.
The CRITICS-II is a randomized phase II trial and designed to identify the optimal preoperative regimen in operable gastric cancer by comparing three investigational treatment arms: chemotherapy vs. chemotherapy and subsequent chemoradiotherapy vs. chemoradiotherapy, all followed by a D2 resection. After randomizing 207 patients, the trial completed its accrual in March 2024.
The current presentation will revisit CRITICS and highlight preliminary results of CRITICS-II.
References
Cats A et al. Chemotherapy versus chemoradiotherapy following surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, multicentre, randomised, phase 3 trial. Lancet Oncol 19(5): 616-628, 2018.
Slagter AE et al. CRITICS-II: A multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. BMC Cancer 18(1):877, 2018.