演題抄録

臓器別シンポジウム

開催概要
開催回
第58回・2020年・京都
 

Genome医療は外科医の臨床を変えるか

演題番号 : SY1-1

[筆頭演者]
沖 英次:1 
[共同演者]
安藤 幸滋:1、藤本 禎明:1、胡 慶江:1、城後 友望子:1、鉾之原 健太郎:1、中西 良太:1、久松 雄一郎:1、木村 和恵:1、森 正樹:1

1:九州大学・消化器・総合外科

 

Surgery is substantial standard therapy for gastrointestinal cancer, however surgery in not unrelated with progress of genomic testing. Genomic testing will bring great change into surgery in two point. Initially, selection of patient is most beneficial. The target of curative surgery is now clinical Stage I-III patients without distant metastasis. However, some early cancer will have recurrence and some far advanced cancer will not have recurrence. If we can predict the recurrence preciously, we can move to challenging surgery for far advanced cancer or avoid the high aged patients. Next important point is peri-operative treatment. Half of advanced cancer will have recurrence after surgery. Thus, we need to do perioperative chemotherapy. The indication for perioperative chemotherapy has been decided by pathological staging, We will decide this indication by genomic testing. The CIRCULATE Japan is important clinical investigation which cover all these purposes. The CIRCULATE Japan consists of a prospective observational study A, and two accompanying interventional studies B and C. Clinical stage II-III as well as R0-intent Stage IV patients are included. The sample size of the observational study A is 2,500 and ctDNA will be analyzed at time points of pre- and post-surgery regularly within two years. High-risk stage II/low-risk stage III patients who are ctDNA negative at 4-week post-surgery will be included in interventional study B, which is a phase III study comparing surgery alone with adjuvant 4-cycle CAPOX. We will also plan a randomized phase III study to compare an investigational new drug with a placebo as study C in patients with ctDNA positive at any time point even though standard adjuvant chemotherapy has been done.
We may be able to minimize recurrences with genome testing. This will become a ground-breaking clinical trial that combines scientific and artistic-skilled technical aspects of Japanese surgery.

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