One strategy available for better selection of patients for adjuvant therapy is genetic tumor profiling to indentify targetable mutations such as HER-2 which is overexpressed in some gastric cancers.
A promising approach for identifying patients who might benefit from neoadjuvant therapy involves tumor uptake of fluorodeoxyglucose on positron-emission tomography (FDG-PET). In the MUNICON phase II trial (Lancet Oncol 2007;8:797-805), patients deemed to be responders, defined by decreases in tumor glucose standard uptake values (SUVs), had a median event-free survival of 29.7 months compared with 14.1 months in nonresponders (hazard ratio 2.18, P = .002), and 29 of 29 of 50 metabolic responders (58% ) had major histologic remissions, whereas none of the metabolic nonresponders did.
Dr. Coit reported having no financial disclosures.