MAGIC
Trial question
Is perioperative chemotherapy plus surgery superior to surgery alone in patients with resectable gastroesophageal cancer?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
21.0% female
79.0% male
N = 503
503 patients (107 female, 396 male).
Inclusion criteria: patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus.
Key exclusion criteria: receipt of cytotoxic chemotherapy or radiotherapy; uncontrolled cardiac disease; CrCl ≤ 60 ml/min.
Interventions
N=250 perioperative chemotherapy plus surgery (A regimen consisting of epirubicin, cisplatin, and fluorouracil for three cycles perioperatively and three cycles postoperatively plus surgery).
N=253 surgery alone (surgery alone without chemotherapy).
Primary outcome
Overall survival
40.4%
32.8%
40.4 %
30.3 %
20.2 %
10.1 %
0.0 %
Perioperative chemotherapy plus
surgery
Surgery
alone
Significant
increase ▲
NNT = 13
Significant increase in overall survival (40.4% vs. 32.8%; HR 1.33, 95% CI 1.06 to 1.67).
Secondary outcomes
Significant decrease in diameter of resected tumor (3 cm vs. 5 cm; AD -2 cm, 95% CI -3.19 to -0.81).
Safety outcomes
No significant differences in postoperative complications, deaths within 30 days after surgery.
Conclusion
In patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus, perioperative chemotherapy plus surgery was superior to surgery alone with respect to overall survival.
Reference
David Cunningham, William H Allum, Sally P Stenning et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6;355(1):11-20.
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