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RESOLVE (phase 3, final report): SOX linked to overall survival advantage vs CapOx in T4 Asian gastric/GEJ cancer

Limited to patients with cT4a N+ M0 or cT4b Nany M0 disease undergoing D2 gastrectomy, the trial reported an overall survival advantage with perioperative or adjuvant SOX versus adjuvant CapOx.

  • Xiaotian Zhang, MD; Han Liang, MD; Ziyu Li, MD; Yingwei Xue, MD; Yanong Wang, MD; Zhiwei Zhou, MD; et al.

  • February 11, 2025

  • The Lancet Oncology
  • The Lancet Oncology, Volume 26, Issue 3, Pages 312–319
  • 10.1016/S1470-2045(24)00676-4

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Evidence before this study

We searched PubMed and the abstracts of the American Society of Clinical Oncology, European Society for Medical Oncology, and Chinese Society of Clinical Oncology and other major oncology congresses with the keywords “D2” OR “locally advanced” AND “gastric cancer” AND “perioperative” for articles published between Jan 1, 2000, and Dec 31, 2020. Different perioperative regimens have been assessed in many trials; however, the optimal modality of perioperative therapy for patients with T4 stage, resectable, locally advanced gastric and gastro-oesophageal junction cancers is unknown. Perioperative administration of S-1 and oxaliplatin have not been reported in patients with resectable locally advanced gastric cancer. A gap still exists in comprehensive data regarding identifying patients who would most benefit from chemotherapy.

Added value of this study

In this final report of the randomised, open-label, phase 3 RESOLVE trial, we confirm the overall survival benefit of perioperative chemotherapy in Asian gastric and gastro-oesophageal junction adenocarcinoma patients in a randomised controlled trial. We observed a survival advantage with perioperative-SOX and adjuvant-SOX in treating patients with locally advanced gastric and gastro-oesophageal junction adenocarcinoma undergoing D2 gastrectomy, compared with the standard adjuvant-CapOx regimen. Importantly, we only included patients with cT4a N+ M0 or cT4b Nany M0 disease. In addition, the advantages of perioperative-SOX in patients with N+ disease in the subgroup analysis might assist in identifying those Asian patients who are most likely to benefit from perioperative chemotherapy in clinical practice.

Implications of all the available evidence

The findings of this study suggest that the SOX regimen, when given perioperatively or as an adjuvant treatment, is a potential standard treatment modality for locally advanced gastric and gastro-oesophageal junction cancer in Asian patients.

Source: The Lancet Oncology

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