JSCO2016: FACO/JSCO Joint Symposium

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


FACO/JSCO Joint Symposium: FACO Clinical Trials-The 1st One and the Next-


FACO first clinical trial - Update of international retrospective cohort study of conversion therapy for Stage Ⅳ gastric cancer (CONVO-GC)-1
Kazuhiro Yoshida (Department of Surgical Oncology, Gifu University)
FACO was founded on 11 Feb 2012 as an organization of Clinical Oncology in Asia with collaboration with Japan, Korea and China. One of its man roles is to perform clinical trials and translation research to develop gold standard therapies and cancer care in Asia. As a candidate for initial clinical trial was decided to perform on gastric cancer on 26 Sept 2013.
The first FACO clinical Trial, CONVO-GC-1 has been successfully started its patient enrollment from First of April, 2016. Generally, conversion therapy can be defined as a surgical treatment aiming at an R0 resection after chemotherapy, for tumors that were originally technically and/or oncologically unresectable or marginally resectable. We have proposed new categories of classification of stage IV gastric cancer standing on the biology of the tumors and treatment strategy for the patients. Stage IV GC patients can be divided based on the absence (categories 1 and 2) or presence (category 3 and 4) of macroscopically detectable peritoneal dissemination. Category 1 is defined oncologically as stage IV but the metastasis is technically resectable. Category 2 includes a marginally resectable metastasis or patients for whom the operation would not necessarily be the best the choice. Category 3 includes a potentially unresectable metastasis of peritoneal dissemination that is only macroscopically detectable. Category 4 includes non-curable metastasis with peritoneal and other organ metastasis. The indications for conversion therapy might include the patients from category 2, some patients from category 3 and very small number of patients from category 4. The provision of conversion therapy for stage IV GC patients might be one of the main roles of surgical oncologists in the near future and the FACO first trial will collect the basic data among Asian countries.


FACO clinical trials: The first clinical trial, perspective from KACO
Hyun Cheol Chung (Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Korea)
Systemic chemotherapy is the standard treatment in unresectable stage IV gastric cancer. However, for the intermittent extremely sensitive patients to the palliative chemotherapy, surgical treatment has been applied to prolong survival (conversion surgery). As few reports showed survival prolongation in selected patients in a retrospective analysis, a strong need for the consensus of indication to conversion surgery and validation of therapeutic efficacy of conversion surgery has been raised in Asia.

For the consensus generation, there are so many issues in patient selection criteria and treatment algorism. (1) Definition on unresectability is different surgeon to surgeon and institution to institution. It can be determined either image-based or surgery-based (laparoscopy or explo-laparotomy). Unresectability might be determined based on the loco-regional spread or systemic metastasis (intra-abdominal or extra-abdominal). (2) The exact surgical intervention time point is a big controversial issue. Surgery can be done after a fixed cycle of chemotherapy or at the maximum response period. And for the maximum response, sequential treatment with different chemotherapy regimens can be applied. (3) Definition of curative surgery is complicated in para-aortic lymph node metastasis case, peritoneal cytology positive case, and systemic metastasis case. (4) The criteria for the selection of adjuvant chemotherapy regimen and duration of the treatment is another issues. Most of the current reports showed survival prolongation of conversion surgery compared to the non-responsive patients to the first-line systemic chemotherapy. We do not know whether conversion surgery may have survival prolongation compared to the responders to the first-line treatment having subsequent chemotherapy with different regimens. The perspectives of KACO for these issues will be discussed.


1st clinical trial: Perspective from CSCO about conventional therapy for gastric cancer
Jiafu Ji (Peking University Cancer Hospital & Institute, China)
In China, nearly 31.2% gastric cancer patients diagnosed as metastatic gastric cancer (mGC). The standard treatment of mGC has not come to concordance. The effect of surgery for mGC is under debated. On the one hand, palliative chemotherapy for mGC progressed very slowly. On the other hand, surgical skills and instruments has developed quickly. As a result, the morbidity and mortality decreased obviously in recent years, which created an opportunity for surgery in mGC patients.
Conventional therapy is regarded as to perform R0 resection after preoperative therapy for patients with potentially resectable metastatic or unresectable cancer.
The area of mGC is mainly peritoneum, No. 16 metastasis, liver and ovary. For patients with peritoneal carcinomatosis, CCOG 0301 study concluded that gastrectomy plus S-1 postoperative chemotherapy improved 5yrs overall survival rate to 20%. The study from our center also implied that cytoreductive surgery plus HIPEC improved survival for patients with peritoneal carcinomatosis. Regarding to No. 16 positive MCG patients, REGATTA subgroup analysis implied that gastrectomy might benefit patients with cN2/N3. JCOG 0405 and 0001 study results also brought us hopes of cure for mGC patients with positive bulky N2 or No. 16 lymph nodes. Concerning liver metastasis, the study from our center elucidated that preoperative followed by surgery could improve survival. As to ovary metastasis, the correlating studies were rare. Our study of heterochronous ovary metastasis concluded that ovariectomy plus HIPEC improved survival.
Recently, FACO/CONVO-GC-1 study has started. This study will clarify the question whether conventional therapy has an effective role for improving the survival of mGC patients. In the future, mGC will no longer be the forbidden zone of surgical treatment, and conventional therapy is the key of surgery for mGC.


A new trial of breast cancer in FACO
Shigeru Imoto (Department of Breast Surgery, Kyorin University Hospital)
Breast cancer is treated with surgery, medicine and radiation on the basis of patient and tumor background. Some early breast patients have disseminated cancer cells in bone marrow and blood as well as advanced patients. Recent technology can detect circulating tumor cells and cell-free DNA in blood from cancer patients. When these biomarkers of liquid biopsy are positive in patients, early relapse or disease progression will be observed. On the other hand, some recurrent breast cancer is diagnosed several years or more after initial treatment of primary disease and also tends to be slowly progressive. Such an indolent disease, especially oligometastatic recurrence, is often managed with combination of loco-regional treatment and systemic treatment. It is not clear understood why delayed recurrence occurs under the circumstances of dormant cancer cells in patients. However, from our experience, delayed and oligometastatic recurrence seems to be curable with appropriate combined treatment. To investigate efficacy of loco-regional and systemic treatment in delayed and oligometastatic recurrence of breast cancer, a registration trial in FACO is being planned. It is considered as the second trial in FACO next to CONVO-GC-1. Trial concept and related issues will be discussed.


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