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PurposeWe report the safety and efficacy of nivolumab+chemotherapy for first-line treatment of advanced or recurrent gastric or gastroesophageal junction cancer in the Korean subpopulation of the ATTRACTION-4 clinical trial.Materials and methodsATTRACTION-4 (NCT02746796) was a double-blind, randomized, placebo-controlled clinical trial of patients aged ≥ 20 years with histologically confirmed unresectable advanced or recurrent gastric or gastroesophageal junction cancer. Patients received nivolumab or placebo, both combined with physician-choice chemotherapy (oxaliplatin plus oral S-1 [tegafur-gimeracil-oteracil] [SOX] or oral capecitabine [CAPOX]).ResultsOverall, 464 patients were initially screened in Korea and 291 were randomized to nivolumab+chemotherapy (total/SOX/CAPOX: 148/66/82 patients) or placebo+chemotherapy (total/SOX/CAPOX: 143/61/82 patients). Centrally assessed progression-free survival (median, 14.75 vs. 8.34 months; hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39 to 0.73; p ConclusionThese findings demonstrate the clinical benefit of nivolumab combined with chemotherapy (either SOX or CAPOX) for first-line treatment of gastric cancer/gastroesophageal junction cancer in Korean patients.

Abstract licence: CC BY

PurposeTo evaluate and compare progression-free survival (PFS) between 50.4-Gy and 60-Gy radiation doses in definitive chemoradiotherapy (CRT) for patients with esophageal cancer, and to confirm that 50.4 Gy is noninferior to the 60-Gy irradiation method in terms of PFS.Methods and materialsPatients with medically inoperable (including patient refusal), unresectable, and/or recurrent esophageal carcinoma referred for definitive CRT were randomly assigned to either the group receiving a total dose of 50.4 Gy in 28 fractions (1.8 Gy/d) for 5.5 weeks or the group receiving a total dose of 60 Gy in 30 fractions (2.0 Gy/d) using involved-field radiation therapy. Chemotherapy consisted of 2 courses of concurrent nedaplatin (80 mg/m2) and tegafur, gimeracil, and oteracil potassium (S-1) (80 mg/m2) in both arms every 4 weeks. The primary end point was PFS.ResultsBetween December 2015 and February 2025, 97 patients with squamous cell carcinoma were included. Radiation treatment was completed in 98% of patients. The median follow-up time for surviving patients was 33.2 months. The 3-year PFS was 45% in the 50.4-Gy group versus 26% in the 60-Gy group (P = .017). The 3-year cumulative local control rate was 65% and 46% for the 50.4-Gy and 60-Gy groups, respectively (P = .047). The 3-year overall survival was 73% and 42% for the 50.4-Gy and 60-Gy groups, respectively (P = .018). Overall, grade 3-4 toxicities were observed in 53% of the 50.4-Gy group versus 51% of the 60-Gy group. The PFS and overall survival differences between the 50.4-Gy and 60-Gy groups were no longer statistically significant after adjustment for key covariates using multivariable analysis.ConclusionsA radiation dose of 50.4 Gy remains the standard dose in concurrent CRT for esophageal squamous cell carcinoma.

Abstract licence: CC BY