Table 1 Summary of the key phase III clinical trials of perioperative and adjuvant chemotherapy in resectable GC

Perioperative chemotherapy

MAGIC

Stage II or higher

3 × ECF → Surgery → 3 × ECF

Surgery

OS

PFS: HR 0.66; 95% CI 0.53–0.81; P < 0.001; 5-year OS: 36% vs. 23% (HR 0.75; 95% CI 0.60–0.93; P = 0.009)

[19]

FNCLCC & FFCD

Resectable

2–3 × CF → Surgery → 3–4 × CF

Surgery

OS

5-year DFS: 34% v 19% (HR, 0.65; 95% CI 0.48 -0.89; P = 0.003) 5-year OS: 38% v 24% (HR, 0.69; 95% CI 0.50 -0.95; P = 0.02)

[20]

FLOT4-AIO

cT2 or higher or N + 

4 × FLOT → Surgery → 4 × FLOT

3 × ECF/ECX → Surgery → 3 × ECF/ECX

OS

PFS: 30 vs. 18 months (HR 0.75; 95% CI 0.62–0.91; P = 0.0036); OS: 50 vs. 35 months (HR 0.77; 95% CI 0.63–0.94; P = 0.012)

[21]

PRODIGY

cT2-3N + , or cT4Nany

3 × DOS → Surgery → 8 × S-1

Surgery → S-1

PFS

3-year PFS: 66.3% vs. 60.2% (HR 0.70; 95% CI, 0.52–0.95; P = 0.023); 3-year OS: 74.2% vs. 73.4% (HR 0.84; 95% CI, 0.60–1.19; P = 0.338)

[22]

RESOLVE

cT4aN + or cT4bNany

Arm C: 3 × SOX → Surgery → 5 × SOX → 3 × S-1

Arm A: Surgery → 8 × CAPOX

DFS

3-year DFS: 59.4% vs. 51.1% (HR 0.77; 95% CI, 0.61–0.97; P = 0.028)

[24]

Adjuvant chemotherapy

ACTS-GC

Stage II or III

Surgery → S-1 for 1 year

Surgery

OS

5-year OS: 71.7% vs. 61.1% (HR 0.669; 95% CI, 0.540 to 0.828)

[27]

CLASSIC

Stage II-IIIB

Surgery → 8 × CAPOX

Surgery

DFS

5-year DFS: 68% vs. 53% (HR 0.58; 95% CI, 0.47 to 0.72; P < 0.0001) 5-year OS: 78% vs. 69% (HR 0.66; 95% CI, 0.51 to 0.85; P = 0.0015)

[25] [26]

JACCRO GC-07

Stage III

Surgery → 1 × S-1 → 7 × Docetaxel plus S-1 → S-1 for 1 year

Surgery → S-1 for 1 year

RFS

3-year RFS: 66% vs. 50% (HR 0.632; 99.99% CI, 0.400 to 0.998; P < 0.001)

[23]

RESOLVE

cT4aN + or cT4bNany

Arm B: Surgery → 8 × SOX

Arm A: Surgery → 8 × CAPOX

DFS

3-year DFS: 56.5% vs. 51.1% (HR 0.86; 95% CI, 0.68 to 1.07; P = 0.17)

[24]