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Older adults with resectable gastric cancer undergoing perioperative chemotherapy or preoperative chemoradiotherapy plus perioperative chemotherapy: A secondary analysis of the AGITG TOPGEAR phase III trial.

Alexander Rühle·Alina Krause·Rachel L O'Connell·John Simes·Michael Michael·Bernard Mark Smithers·Rebecca K S Wong·Karin Haustermans·Nils H Nicolay·Trevor Leong·Florian Lordick
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Abstract

PURPOSE: To evaluate treatment adherence, adverse events, and survival in older (&#x2265;70 years) adults undergoing perioperative treatment for gastric cancer. METHODS: Patients with resectable gastric/gastro-esophageal junction adenocarcinoma (ECOG 0-1) enrolled in the phase III TOPGEAR trial were randomized to perioperative chemotherapy (ECF/ECX or FLOT) alone or perioperative chemotherapy plus preoperative chemoradiotherapy (45&#x202f;Gy in 25 fractions with concurrent fluoropyrimidine). In this exploratory analysis, treatment completion, grade &#x2265;&#x202f;3 adverse events (CTCAE v3.0), surgical outcomes, overall survival (OS) and progression-free survival (PFS) were compared between older and younger adults. RESULTS: Of the 574 patients enrolled, 135 (24%) were &#x2265;&#x202f;70 years. Older adults more frequently required preoperative chemotherapy dose reductions, omissions, or delays (chemoradiotherapy: 55% vs 35%, p&#x202f;=&#x202f;0.004; chemotherapy: 60% vs 48%, p&#x202f;=&#x202f;0.087). Rates of grade &#x2265;&#x202f;3 adverse events were comparable between older and younger patients (chemoradiotherapy: 66% vs 67%, p&#x202f;=&#x202f;0.874; chemotherapy: 68% vs 59%, p&#x202f;=&#x202f;0.220), but older adults more often had hematologic toxicity and grade &#x2265;&#x202f;3 diarrhea in the chemotherapy group (56% vs 37%, p&#x202f;=&#x202f;0.006; 21% vs 6%, p&#x202f;<&#x202f;0.001). Resection rates, grade 3/4 surgical complications, number of removed lymph nodes, and 30-/90-day mortality were similar by age. OS and PFS were comparable across age groups, with numerically favorable outcomes for older adults (OS: HR 0.86, 95% CI 0.58-1.26 [chemoradiotherapy]; HR 0.75, 95% CI 0.51-1.11 [chemotherapy]; PFS: HR 0.78, 95% CI 0.53-1.15 [chemoradiotherapy]; HR 0.70, 95% CI 0.47-1.03 [chemotherapy]). CONCLUSIONS: Older adults with gastric cancer achieved comparable oncologic outcomes to younger patients, despite more frequent treatment modifications and higher hematologic toxicity.

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HumansStomach NeoplasmsAgedFemaleMaleAntineoplastic Combined Chemotherapy ProtocolsAdenocarcinomaAged, 80 and overAge FactorsNeoadjuvant TherapyMiddle AgedChemoradiotherapyGastrectomyGeriatric oncologyPostoperative ComplicationsRadiotherapySurvival AnalysisTreatment OutcomeJournal ArticleClinical Trial, Phase IIIRandomized Controlled TrialMulticenter Study

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Alexander R&#xfc;hle, Alina Krause, Rachel L O'Connell, John Simes, Michael Michael, Bernard Mark Smithers, Rebecca K S Wong, Karin Haustermans, Nils H Nicolay, Trevor Leong, Florian Lordick. 2026-08-22. Older adults with resectable gastric cancer undergoing perioperative chemotherapy or preoperative chemoradiotherapy plus perioperative chemotherapy: A secondary analysis of the AGITG TOPGEAR phase III trial.. https://doi.org/10.1016/j.ejca.2026.117005

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Age Factors subjectAged subjectAged, 80 and over subjectAntineoplastic Combined Chemotherapy Protocols subjectClinical Trial, Phase III subjectFemale subjectHumans subjectJournal Article subjectJournal Article; Clinical Trial, Phase III; Randomized Controlled Trial; Multicenter Study resourceMale subjectMiddle Aged subjectMulticenter Study subjectRandomized controlled trials study

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