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Clinical
Implementation

Standard of Care: Current Treatment for Gastric Cancer

The current standard of care for resectable, stage II–III gastric cancer includes adjuvant chemotherapy after surgery to prevent disease recurrence and improve survival. The use of this regimen is largely based on the results of the CLASSIC trial, which reported a survival improvement in patients with gastric cancer treated with adjuvant capecitabine plus oxaliplatin after primary gastrectomy with D2 lymph node dissection compared with patients who received surgery alone. However, in the 5-year follow-up analysis of the CLASSIC trial, overall survival in the surgery-only group was 69% compared with 78% in the adjuvant chemotherapy group, with a moderate absolute benefit from adjuvant chemotherapy of 9%. These findings highlight the need for a predictive test that identifies patients with resectable gastric cancer at different risk of recurrence and determines the likelihood of chemotherapy benefit.

Prediction of post-operative prognosis is a result after considering several factors such as TNM staging classification, genetic and environmental factors, etc. and knowing the prognosis is one of important factors that help identifying treatment plans or methods. However, more than 20.5% patients with gastric cancer experienced recurrence after gastrectomy and this highlights the need for a prognostic risk classification system.

A more precise prediction of prognosis contributes providing personalized treatment by identifying patients group who might require additional treatment or reducing treatments that might likely cause side effects than benefit. A research showed that providing information on operation methods, surgical procedure, post-operative care had positive effects on anxiety in patients with gastric cancer. Additionally, according to National Cancer Information Center (NCIC) in Korea, patients undergoing chemotherapy are highly experiencing side effects such as hair loss, infection, nausea and vomiting, appetite changes, diarrhea, etc. Therefore, avoiding unnecessary chemotherapy would significantly reduce physical burdens. Moreover, based on the research from National Cancer Center Korea (2014), 84.1% of cancer patients lose their job or quit working due to long-term cancer treatment and the psychological health problems, leading to economic and social burden.

Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim SW, Kim HH, Choi JH, Kim HK, Yu W, Lee JI, Shin DB, Ji J, Chen JS, Lim Y, Ha S, Bang YJ; CLASSIC trial investigators. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014 Nov;15(12):1389-96.

The classification of prognosis and chemotherapy response with nProfiler® 1 Stomach Cancer Assay was validated in CLASSIC validation trial.

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First In Clinical: nProfiler® 1; Molecular Diagnostics Test for Prognosis and Chemotherapy Response of Gastric Cancer

The clinical utility in prognostic diagnosis is used as an objective indicator of evidence-based medicine, and this would help clinicians identifying treatment decisions.

Type Treatment Recommendation for Clinicians
IM Type
  • High expression of immune genes (GZMB, WARS; Immune gene classifier) which related to immune regulation and inflammatory response
  • Good Prognosis and no benefit from standard adjuvant chemotherapy
  • May result in fewer side effects by reducing dose or the number of cycles of chemotherapy
ST Type
  • High expression of Stem-like gene (SFRP4; Stem-like classifier) which is a WNT signaling-associated EMT modulator and low expression of immune genes
  • Bad prognosis and no benefit from standard adjuvant chemotherapy
  • Consider additional therapy not only standard adjuvant chemotherapy after surgery
EP Type
  • High expression of Epithelial gene (CDX1; Epithelial gene classifier) which is a biomarker for gastric intestinal metaplasia (precancerous lesion) and low expression of immune genes
  • Recommend current standard adjuvant chemotherapy after surgery

nProfiler® 1 addresses the unmet medical needs of cancer patients from over-treatment and under-treatment through patient prognosis classification. Appropriate treatment (personalized treatment) according to each risk classification will bring positive effects on improvement of quality of life and overall survival rate.