Triplet Chemotherapy with Cisplatin versus Oxaliplatin in the CRITICS Trial: Treatment Compliance, Toxicity, Outcomes and Quality of Life in Patients with Resectable Gastric Cancer

Simple Summary Perioperative chemotherapy is the current standard treatment for patients with resectable gastric cancer. Either cisplatin or oxaliplatin could be part of the chemotherapy regimen, of which oxaliplatin is currently most used in the standard treatment. Evidence to choose oxaliplatin over cisplatin in the curative setting is limited. In this study, we compared cisplatin versus oxaliplatin in patients with resectable gastric cancer treated with pre- and postoperative chemotherapy. Adverse events were not different for patients who received cisplatin versus those who received oxaliplatin, nor was compliance with the treatment regimen. We could not detect survival differences between patients treated with cisplatin versus oxaliplatin. Diarrhea more frequently impacted patients treated with oxaliplatin than patients treated with cisplatin. As hydration is not needed for oxaliplatin, it is more practical to use in daily care. In conclusion, both cisplatin and oxaliplatin are legitimate options as part of systemic treatment in patients with resectable gastric cancer. (1) Background: Perioperative chemotherapy is the current standard treatment for patients with resectable gastric cancer. Based on studies in patients with metastatic gastric cancer, oxaliplatin has replaced cisplatin in the curative setting as well. However, evidence to prefer oxaliplatin over cisplatin in the curative setting is limited. (2) Methods: We compared patient-related and tumor-related outcomes for cisplatin versus oxaliplatin in patients with resectable gastric cancer treated with perioperative chemotherapy in the CRITICS trial. (3) Results: Preoperatively, 632 patients received cisplatin and 149 patients received oxaliplatin. Preoperative severe toxicity was encountered in 422 (67%) patients who received cisplatin versus 89 (60%) patients who received oxaliplatin (p = 0.105). Severe neuropathy was observed in 5 (1%) versus 6 (4%; p = 0.009) patients, respectively. Postoperative severe toxicity occurred in 109 (60%) versus 26 (51%) (p = 0.266) patients; severe neuropathy in 2 (1%) versus 2 (4%; p = 0.209) for patients who received cisplatin or oxaliplatin, respectively. Diarrhea impacted the quality of life more frequently in patients who received oxaliplatin compared to cisplatin. Complete or near-complete pathological response was achieved in 94 (21%) versus 16 (15%; p = 0.126) patients who received cisplatin or oxaliplatin, respectively. Overall survival was not significantly different in both groups (p = 0.300). (4) Conclusions: Both cisplatin and oxaliplatin are legitimate options as part of systemic treatment in patients with resectable gastric cancer.

Automated summary

Perioperative chemotherapy is the standard treatment for patients with resectable gastric cancer, and both cisplatin and oxaliplatin are legitimate options. This study compared the effectiveness of cisplatin and oxaliplatin in these patients and found no significant differences in adverse events, treatment compliance, or survival rates. However, oxaliplatin treatment was associated with a higher incidence of diarrhea compared to cisplatin treatment.