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Al-Batran SE, Goetze TO, Mueller DW, Vogel A, Winkler M, Lorenzen S, Novotny A, Pauligk C, Homann N, Jungbluth T, Reissfelder C, Caca K, Retter S, Horndasch E, Gumpp J, Bolling C, Fuchs KH, Blau W, Padberg W, Pohl M, Wunsch A, Michl P, Mannes F, Schwarzbach M, Schmalenberg H, Hohaus M, Scholz C, Benckert C, Knorrenschild JR, Kanngießer V, Zander T, Alakus H, Hofheinz RD, Roedel C, Shah MA, Sasako M, Lorenz D, Izbicki J, Bechstein WO, Lang H, Moenig SP. The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction - a phase III trial of the German AIO/CAO-V/CAOGI. BMC Cancer 2017; 17:893. [PMID: 29282088 PMCID: PMC5745860 DOI: 10.1186/s12885-017-3918-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background Historical data indicate that surgical resection may benefit select patients with metastatic gastric and gastroesophageal junction cancer. However, randomized clinical trials are lacking. The current RENAISSANCE trial addresses the potential benefits of surgical intervention in gastric and gastroesophageal junction cancer with limited metastases. Methods This is a prospective, multicenter, randomized, investigator-initiated phase III trial. Previously untreated patients with limited metastatic stage (retroperitoneal lymph node metastases only or a maximum of one incurable organ site that is potentially resectable or locally controllable with or without retroperitoneal lymph nodes) receive 4 cycles of FLOT chemotherapy alone or with trastuzumab if Her2+. Patients without disease progression after 4 cycles are randomized 1:1 to receive additional chemotherapy cycles or surgical resection of primary and metastases followed by subsequent chemotherapy. 271 patients are to be allocated to the trial, of which at least 176 patients will proceed to randomization. The primary endpoint is overall survival; main secondary endpoints are quality of life assessed by EORTC-QLQ-C30 questionnaire, progression free survival and surgical morbidity and mortality. Recruitment has already started; currently (Feb 2017) 22 patients have been enrolled. Discussion If the RENAISSANCE concept proves to be effective, this could potentially lead to a new standard of therapy. On the contrary, if the outcome is negative, patients with gastric or GEJ cancer and metastases will no longer be considered candidates for surgical intervention. Trial registration The article reports of a health care intervention on human participants and is registered on October 12, 2015 under ClinicalTrials.gov Identifier: NCT02578368; EudraCT: 2014–002665-30.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - Thorsten O Goetze
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Daniel W Mueller
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Arndt Vogel
- Department of Internal Medicine, Hannover Medical School, 30625, Hannover, Germany
| | - Michael Winkler
- Department of Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Sylvie Lorenzen
- Department of Internal Medicine, Klinikum rechts der Isar der TU München, 81675, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar der TU München, 81675, Munich, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Nils Homann
- Department of Internal Medicine II, Academic Teaching Hospital Wolfsburg, 05361, Wolfsburg, Germany
| | - Thomas Jungbluth
- Department of Surgery, Academic Teaching Hospital Wolfsburg, 05361, Wolfsburg, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Hospital Carl Gustav Carus Dresden, 01307, Dresden, Germany
| | - Karel Caca
- Department of Internal Medicine, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany
| | - Steffen Retter
- Department of Surgery, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany
| | - Eva Horndasch
- Department of Internal Medicine, Kliniken des Landkreises Neumarkt, 92318, Neumarkt, Germany
| | - Julia Gumpp
- Department of Surgery, Kliniken des Landkreises Neumarkt, 92318, Neumarkt, Germany
| | - Claus Bolling
- Department of Internal Medicine, Agaplesion Markus Krankenhaus Frankfurter, Diakonie Kliniken gGmbH, 60431, Frankfurt, Germany
| | - Karl-Hermann Fuchs
- Department of Surgery, Agaplesion Markus Krankenhaus Frankfurter Diakonie Kliniken gGmbH, 60431, Frankfurt, Germany
| | - Wolfgang Blau
- Department of Medical Oncology, Gießen University Hospital, 35392, Gießen, Germany
| | - Winfried Padberg
- Department of Surgery, Gießen University Hospital, 35392, Gießen, Germany
| | - Michael Pohl
- Department of Internal Medicine, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Andreas Wunsch
- Department of Surgery, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Patrick Michl
- Department of Medical Oncology, Halle University Hospital, 06120, Halle (Saale), Germany
| | - Frank Mannes
- Department of Internal Medicine, Halle University Hospital, (Saale), 06120, Halle, Germany
| | | | - Harald Schmalenberg
- Department of Internal Medicine IV, Städtisches Klinikum Dresden, 01067, Dresden, Germany
| | - Michael Hohaus
- Department of Surgery, Städtisches Klinikum Dresden, 01067, Dresden, Germany
| | - Christian Scholz
- Department of Medical Oncology, Vivantes Klinikum Am Urban Berlin, 10967, Berlin, Germany
| | - Christoph Benckert
- Department of Surgery, Vivantes Klinikum Am Urban Berlin, 10967, Berlin, Germany
| | | | - Veit Kanngießer
- Department of Surgery, Marburg University Hospital, 35043, Marburg, Germany
| | - Thomas Zander
- Department of Internal Medicine, University Hospital Köln, 50937, Köln, Germany
| | - Hakan Alakus
- Department of Surgery, University Hospital Köln, 50937, Köln, Germany
| | | | - Claus Roedel
- Department of Radiation- Oncology, Frankfurt University Hospital, 60590, Frankfurt, Germany
| | - Manish A Shah
- Department of Medicine Hematology and Oncology, Weill Cornell Medicine, New York, USA
| | - Mitsuru Sasako
- Department of Surgery, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Dietmar Lorenz
- Department of General and Visceral Surgery, Sana- Klinikum Offenbach, 63069 Offenbach, Hamburg, Germany
| | - Jakob Izbicki
- Department of Surgery, Hamburg University Hospital, 20246, Hamburg, Germany
| | - Wolf O Bechstein
- Department of Surgery, Frankfurt University Hospital, 60590 Frankfurt, Hamburg, Germany
| | - Hauke Lang
- Department of Surgery, Mainz University Hospital, 55131, Mainz, Germany
| | - Stefan P Moenig
- Hôpitaux Universitaires de Genève, Service de Chirurgie viscéral, 1205, Genève, Switzerland
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