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Background <p>The completion rate of adjuvant chemotherapy for gastric cancer (GC) is suboptimal, particularly in elderly patients. While neoadjuvant chemotherapy (NAC) for locally advanced GC has shown promise, data on elderly patients remain limited. Given the considerable physical burden of NAC, optimizing its administration is crucial. This study evaluates the safety and efficacy of a modified approach for elderly patients.</p> Methods <p>A retrospective analysis was conducted on 38 patients with cStage II/III GC who received NAC between November 2015 and December 2023. Additionally, 25 patients aged ≥ 75 years with cStage III who underwent upfront surgery during the same period were analyzed.</p> Results <p>The NAC group was divided into non-elderly (&lt; 75 years, <i>n</i> = 27) and elderly (≥ 75 years, <i>n</i> = 11) groups. The elderly group had poorer ECOG-PS (<i>p</i> = 0.016). While all non-elderly patients completed ≤ 3 cycles, more elderly patients underwent 4 cycles (<i>p</i> = 0.0047). However, per-cycles of S-1 (<i>p</i> = 0.0003) and oxaliplatin (<i>p</i> = 0.0018) were lower in the elderly group. Importantly, adverse events and treatment efficacy were comparable between groups. Among patients aged ≥ 75 years, the upfront surgery group had poorer ECOG-PS (<i>p</i> = 0.017) and underwent more frequent distal gastrectomy (<i>p</i> = 0.014).</p> Conclusions <p>NAC can be safely administered to elderly patients by increasing cycles while reducing per-cycle dosage. It may also serve as a viable alternative to upfront surgery.</p>

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Neoadjuvant chemotherapy strategies for optimizing safety and efficacy in elderly patients with locally advanced gastric cancer

  • 期刊论文

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  • 发表日期：

    2025年9月29日

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  • Yoshihiko Kakiuchi,
  • Shinji Kuroda,
  • Shunya Hanzawa,
  • Nobuhiko Kanaya,
  • Hajime Kashima,
  • Satoru Kikuchi,
  • Kunitoshi Shigeyasu,
  • Shunsuke Kagawa,
  • Toshiyoshi Fujiwara

摘要

Background

The completion rate of adjuvant chemotherapy for gastric cancer (GC) is suboptimal, particularly in elderly patients. While neoadjuvant chemotherapy (NAC) for locally advanced GC has shown promise, data on elderly patients remain limited. Given the considerable physical burden of NAC, optimizing its administration is crucial. This study evaluates the safety and efficacy of a modified approach for elderly patients.

Methods

A retrospective analysis was conducted on 38 patients with cStage II/III GC who received NAC between November 2015 and December 2023. Additionally, 25 patients aged ≥ 75 years with cStage III who underwent upfront surgery during the same period were analyzed.

Results

The NAC group was divided into non-elderly (< 75 years, n = 27) and elderly (≥ 75 years, n = 11) groups. The elderly group had poorer ECOG-PS (p = 0.016). While all non-elderly patients completed ≤ 3 cycles, more elderly patients underwent 4 cycles (p = 0.0047). However, per-cycles of S-1 (p = 0.0003) and oxaliplatin (p = 0.0018) were lower in the elderly group. Importantly, adverse events and treatment efficacy were comparable between groups. Among patients aged ≥ 75 years, the upfront surgery group had poorer ECOG-PS (p = 0.017) and underwent more frequent distal gastrectomy (p = 0.014).

Conclusions

NAC can be safely administered to elderly patients by increasing cycles while reducing per-cycle dosage. It may also serve as a viable alternative to upfront surgery.