Nowadays for patients who have localised gastric or oesophageal-gastric junction adenocarcinoma we tend to use multimodality treatment for patients who are fit and healthy. There are different ways to do this; we can either give post-operative treatment, which is favoured mainly in Japan and other parts of Asia, whereas in Europe and the US we tend to give pre-operative treatment nowadays. For oesophageal gastric junction adenocarcinoma there is an option of either giving pre-operative chemoradiation based on originally the CROSS study. But perhaps one of the most important data that have been presented originally at ASCO a few weeks ago but also today as well, just before my presentation, is the result from the German FLOT4 study which is using a regimen including oxaliplatin, docetaxel, 5FU, leucovorin and giving that treatment before and after. It was compared in a large phase III study of over 700 patients versus the old standard of giving perioperative epirubicin, cisplatin and capecitabine. In this study it significantly improved progression free survival and overall survival.
So today my presentation where I was really discussing that with the audience and I think people generally feel we can adopt this as a new standard option in the treatment if you have operable gastric cancer and oesophageal-gastric junction adenocarcinoma. However, as that study was only performed in Germany clinicians outside Germany will now need to learn how to give this regimen in order to benefit our patients.