The 92nd Annual Meeting
of the Japanese Gastric Cancer
Association

Genomic profiling is being performed to identify targetable genomic alterations for various types of cancers. However, HER2 is the only validated predictive genomic biomarker for advanced gastric cancer so far. Recent comprehensive molecular analyses have enabled deeper understanding of the biological characteristics of gastric cancer. We would like to discuss how we utilize genomic profiling data based on the molecular characteristics of gastric cancer to improve outcomes.

Recently, the number of EGJ cancer has increased in Japan. In this session, the latest findings regarding diagnosis, endoscopic treatment, or perioperative therapy for EGJ cancer should be presented.

There is a lot of arguments concerning surgical procedures for EGJ cancer. A multi-center prospective cohort study has provided certain findings regarding optimal extent of lymph node dissection, however it is still debatable in terms of its approach or reconstruction ways. In this session, the latest surgical procedures for EGJ cancer would be presented by the surgeons at the front line.

This session summarizes the already established evidences for minimally invasive gastric cancer surgery (Laparoscopic or Robotic surgery). Additionally, actual problems in extrapolating or implementing them to the clinical practice are expected to be discussed. Future positioning of robotic surgery in the treatment of gastric cancer will be also shown.

There are still differences between East and West in the treatment strategy for gastric cancer. Since global clinical trials are hoped to be carried out, the bridging between East and West will be more important than ever. The purpose of this session is to understand the differences well, and to consider future infrastructure for collaboration.

Recently, immune checkpoint inhibitors such as anti-PD-1/PD-L1 antibodies or anti-CTLA-4 antibodies has emerged as a promising strategy in several malignancies. A phase III ATTRACTION-2 trial of nivolumab for patients with advanced gastric cancer (AGC) after two or more previous line chemotherapies showed a survival benefit, leading to the approval of nivolumab for AGC in Japan. However, subsequent phase III trials of pembrolizumab in earlier treatment lines failed to exhibit a survival benefit compared with standard chemotherapies. Thus, better biomarkers of immune checkpoint inhibitors or combination therapy should be established in the near future. In this session, we would like to discuss current status or future directions of immune checkpoint inhibitors for gastric cancer.

As a peri-operative chemotherapy, post-operative doublet chemotherapy based on oral fluoropyrimidine is widely used for pStage III gastric cancer in Japan while preoperative chemotherapy with FLOT is a standard care for resectable gastric cancer in western countries. For the further improvement of resectable gastric cancer, multi-disciplinary approach plays an important role. However, there are so many issues to be solved such as indication, chemotherapy regimen, timing of chemotherapy. In this session, we would like to discuss about these issues based on the evidence and future directions of the on-going clinical trials.

ESD has been widely spread as a standard treatment for early gastric cancer worldwide because of less invasiveness and high curability. In recent, various medical innovation including traction device or robotic technology has been introduced to improve ESD in technique. And, collaborative treatment consisting of luminal endoscopic and laparoscopic procedures represented by LECS has been developed and reported its utility in the treatment for gastric tumor. In this session, we would like to recruit the submission various challenging minimal invasive endoscopic procedure beyond ESD for gastric tumor.

This session summarizes the already established evidences for gastric cancer surgery. Additionally, actual problems in extrapolating or implementing them to the clinical practice are expected to be discussed.

Imatinib was first introduced to the Case 0 patient with metastatic GIST in March 2000 and immediately showed revolutionary activities, which strongly promoted medical development of molecularly targeted agents, which is, eventually, connected to genomic medicine. During the two decades, additional two drugs (sunitinib & regorafenib) have been approved, clinical guidelines are published, and detailed molecular mechanisms of GIST and sub-fractions with very rare driver mutations have been discovered. As a result, in EU & USA, international clinical trials have been conducted even in rare cancer, and, in Asia, Asian consensus GIST guidelines is published and the neoadjuvant clinical trial was conducted.
GIST is well-elucidated disease among rare cancers, however, it still has several challenges in diagnosis and treatment. In this symposium, speakers should address present challenges and future perspectives in diagnosis, and surgical, medical and multidisciplinary treatment of GIST.

In Japan, endoscopic examination was accepted as a population based screening for gastric cancer in 2016. Introduction of endoscopic examination is expected not only to reduce gastric cancer death but also to detect gastric cancer at early stage, however, there are several unsolved issues including the responsibility to build double check system. Furthermore, several early gastric cancer cases which are difficult to diagnose using ordinary knowledge of endoscopy diagnosis has been reported recently, because of decreasing of the H.pylori infection rate. It is very important to arrange the new endoscopic findings of early gastric cancer to fit the new era of H.pylori negative stomach. In this session, we would like to recruit the submission including the success cases or unmet task for introduction of population based endoscopic screening or new modality to improve early gastric cancer detection.

Standard chemotherapy for gastric cancer includes cytotoxic agents, HER2 targeting therapy and VEGFR2 targeting therapy. Also, immune check point inhibitors will be introduced in near future. However, efficacy of these treatments is still not sufficient without patient’s enrichment and we have many negative trials with other agents. So, more efficient strategy might be necessary based on its biology. In this symposium, we would like to discuss ongoing development of newer treatments for gastric cancer.

Since the JCOG0110 conclusions were published, spleen-preservation has become a standard surgery for proximal advanced gastric cancer not invading the greater curvature, while splenectomy is still regarded as a standard method for that invading the greater curvature in many institutions. On the other hand, considering the high incidences of morbidity relevant to splenectomy or its impact to the patient’s prognosis, some institutions support the significance of spleen-preserving surgery. In this session, our direction in terms of this issue should be debated facing unprecedented aging society.

Advances in AI technology are expected to introduce a new diagnostic system. AI technology will be incorporated in imaging medicine, endoscopic medicine, and pathological medicine. In this panel discussion, we will clarify the problems and issues about how AI is involved in gastric cancer medicine.

The number of proximal gastrectomy is growing in the treatment of early-stage upper gastric cancer or esophagogastric junction cancer. Various reconstruction methods have been reported, but a gold standard procedure is not yet established. In this session, pros and cons of each reconstruction method should be demonstrated, and criteria to choose an optimal method for individual patient will be debated.

CONVO-GC-1 study has showed that conversion surgery may provide relatively favorable prognosis to the patients down-staged from Stage IV if R0 resection is achieved. However, there is still argument regarding the appropriate timing of surgery. In this session, optimal treatment strategy for oligometastasis, future perspectives, or necessary design of clinical trials should be discussed.

In 2019, chimeric antigen receptor T-cell cancer therapy (CAR-T) was approved for certain type of leukemia and malignant lymphoma based on single arm clinical trials. Furthermore, oncolytic viral therapy is under review process for Japanese regulatory approval for brain tumor based on a small-size clinical trial. Perspective of these breakthrough therapy for gastric cancer will be discussed.

In recent years, with the aging of the population, the number of elder and super-elder patients with gastric cancer is increasing. It is controversial whether to decide treatments for patients with gastric cancer according to their age. Since comorbidities or functional impairment are more prevalent in elder patients, how to treat them appropriately is still not established. In this session, optimal treatments for elderly patients with early gastric cancer to advanced gastric cancer will be discussed.

Endoscopic diagnosis for gastric cancer including systemic observation, detection and precise diagnosis is the world class academic field that has been built on the basis of continuous effort by master Japanese endoscopists. In recent, Image enhanced endoscopy including NBI, BLI, LCI or magnified endoscopy brings us not only more precise diagnosis but also high quality evidence based new endoscopic diagnosis. In this session, we would like to recruit the submission including the impact of new endoscopic modality including IEE for diagnosis or challenges using more advanced endoscopy like functional imaging for diagnosis of gastric cancer.

The development of biomarker for therapeutic target has not be progressed as we are expecting it to be. Targetable genomic alterations without HER2 amplification still has not be validated. While, the development of therapeutic agents against protein expression itself are being bricked up, because several protein expressions are reported. Recently, immune checkpoint inhibitors are progressed, however, we need to investigate predictive biomarker for immunotherapy in gastric cancer and generalizable assay method, because the efficacy in gastric cancer are still limited. Furthermore, a new useful biomarker for early detection or diagnosis of relapse are also expected. In this symposium, we would like to discuss useful biomarker in early diagnosis to advanced gastric cancer.

Pathological diagnosis is still the basis of treatment of gastric cancer patients. The fifth edition of WHO Classification of Tumours, Digestive System Tumours, was published by IARC Lyon, France, in 2019. The clarifying the point of revision and discussion of the problems of the of the 5th Edition will be held by the editorial pathologists in this symposium. In addition, we discuss the problems of the classification and the directionality of the future gastric cancer classification.

Introduction of diagnostic techniques by AI has already been started at both research and medicine in a various diagnoses of the diseases. In this workshop, I would like to select the areas where the introduction of AI technology to current medical treatment is progressing and discuss on that problems and future direction of AI introduction on the gastric cancer diagnosis and treatment.

Standardized gastric cancer surgery has almost reached perfection. Recently, robotic surgery or navigation surgery using fluorescence endoscopy has been performed for pursuing further accuracy. With investigating the effectiveness and significance of these technologies, future view of gastric cancer surgery will be discussed in this session.

Prognosis of patients with scirrhous-type gastric cancer and peritoneal dissemination is poor because of resistance to conventional chemotherapy. Newer treatment strategy or modality for these patients will be discussed.

Laparoscopic gastrectomy has widely penetrated to the clinical practice, and recently the reports for the conclusions of large-scale prospective studies have been published one after another. On the other hand, many institutions are now attempting to introduce robotic gastrectomy since reimbursement system from the public insurance started in April 2018. For the purpose of advocating safe operative procedures, their technical pitfalls, how to avoid troubles, and trouble-shooting measures should be demonstrated in this session.