Meeting Summary

The second SOTS meeting on GI cancer focused on both defining our current knowledge of the disease and its management, and determining optimal directions for future research. Discussions emphasized a need for further research into molecular etiology. Possible molecular targets along angiogenic and signaling pathways were identified, and new anti-apoptotic agents described. Although the predictive value of biological endpoints in clinical trials was questioned, panelists did view the possibility of genetic profiling for predictive molecular markers optimistically. Presenters delineated the histochemical progression of gastric pre-malignancies into cancer, while debating the precursor role of intestinal metaplasia, and reviewed current hypotheses on H. pylori-initiated pathogenic molecular mechanisms. Advantages of intraperitoneal chemotherapy and chemotherapy specific to tumor biology were explored, as well as pros and cons of a number of new, specific imaging applications, particularly those using PET. Treatment algorithms were suggested for adjuvant chemo + radiation therapy. Surgery talks covered the pros and cons of various surgical and staging techniques for loco-regional control, upheld the utility of the Muruyama index for guiding surgical choices, and described gross patterns of relapse. Trial paradigms and statistical caveats were offered for studying molecularly-directed therapies. Recommendations for expediting progress to phase III study included standardizing radiotherapy and assays across trials; creating an Intergroup tissue repository; and refining classification and staging systems based on molecular markers particular to disease phenotype. Panelists urged the combination of biologic with chemotherapeutic agents in trials, and considered the impacts of etiologic heterogeneity on the planning of future trials.