18 September 2024:

We’re thrilled to announce the release of globally significant results from the AGITG TOPGEAR study on which TROG collaborated, providing practice-changing evidence about preoperative chemoradiotherapy for gastric cancer.

The findings, announced simultaneously at the European Society for Medical Oncology Congress in Barcelona, Spain and published in the New England Journal of Medicine in September, provide an important answer to a long-standing question and have implications for clinical practice worldwide.

The multidisciplinary study, led by the Australasian Gastro-Intestinal Trials Group (AGITG), involved 574 patients across 15 countries and aimed to determine the optimal adjuvant regimen for potentially curable gastric cancer.

In Western countries, the current standard of care for resectable gastric cancer is perioperative chemotherapy but there is also keen interest in preoperative chemoradiotherapy. The trial hypothesised that adding concurrent radiotherapy to standard treatment would improve pathological complete response rates and ultimately overall survival compared to perioperative chemotherapy alone.

Despite improving pathological outcomes, the addition of preoperative chemoradiotherapy to perioperative chemotherapy did not improve overall survival compared to perioperative chemotherapy alone in patients with resectable gastric and gastro-esophageal junction adenocarcinoma.

The results will be practice changing as some centres, particularly in the United States, currently employ preoperative chemoradiotherapy as standard treatment for gastric cancer.

The trial involved the collaborative efforts of TROG Cancer Research, the European Organisation for Research and Treatment of Cancer (EORTC) and the Canadian Cancer Trials Group (CCTG).

TROG successfully led the radiation therapy quality assurance (RTQA) program for the trial, enabling over 200 real-time pre-treatment radiotherapy plan reviews nationally and internationally. This was a significant achievement, as it required careful navigation of time-zones, jurisdictions and treatment timelines (see the RED journal publication on the RTQA program).

Congratulations to Study Chair Professor Trevor Leong, TROG Radiation Therapy manager Alisha Moore, and all involved in the trial worldwide.

Professor Leong, Past President of TROG, commented: “Thank you to everyone involved in AGITG TOPGEAR for their tireless efforts over the duration of this large, academic trial. This trial involved hundreds of people around the world and delivering these findings is a significant achievement that we all should be proud of.”

Read the paper in the New England Journal of Medicine and read more about the trial.