Dr Verheij on Weighing the Benefit of Neoadjuvant Chemotherapy vs CRT for Resectable Gastric Cancer

“Based on the results of CRITICS-II, the total neoadjuvant therapy [TNT] arm is the preferred arm, and should serve as the basis for the next study where we try to compare that with the current standard. [We could also explore] incorporating immunotherapy into the TNT arm.”

Marcel Verheij, MD, PhD, head of the Department of Radiation Oncology at Radboud University Medical Centre, discussed how medical oncologists should weigh the risks and benefits of neoadjuvant chemotherapy vs chemoradiotherapy (CRT)-based strategies for patients with resectable gastric cancer, drawing on data from the phase 2 CRITICS-II trial (NCT02931890) presented at the 2026 ASCO Gastrointestinal Cancers Symposium.

Verheij emphasized that CRITICS-II was designed to optimize preoperative treatment by determining the preferred regimen out of the following 3 approaches: neoadjuvant chemotherapy alone (arm 1), neoadjuvant chemotherapy followed by CRT (arm 2), or neoadjuvant CRT alone (arm 3), all followed by surgery. Arm 1 of the trial consisted of 4 cycles of docetaxel/oxaliplatin/capecitabine; arm 2 consisted of 2 cycles of chemotherapy administered int the same dosing schedule, followed by CRT at 45 Gy plus weekly paclitaxel/carboplatin; and arm 3 consisted of CRT alone. The primary end point was 1-year event-free survival (EFS).

At the 1-year landmark, EFS numerically favored strategies incorporating CRT. EFS was 68% (95% CI, 58%-80%) in arm 1 vs 84% (95% CI, 75%-84%) in arm 2 and 78% (95% CI, 69%-88%) in arm 3.One-year overall survival (OS) rates followed a similar pattern; these were 74% (95% CI, 64%-85%) in arm 1, 89% (95% CI, 81%-97%) in arm 2, and 84% (95% CI, 76%-93%) in arm 3.

Interpreting these data for practice, Verheij framed the key clinical tradeoff as intensification vs simplicity in the neoadjuvant period. Although CRITICS-II was not designed to establish a definitive new standard of care in the preoperative space, the trial data suggest that a “total neoadjuvant therapy” approach—comprising chemotherapy plus CRT before surgery—is the preferred option among these 3 approaches, Verheij stated. Overall, this these findings support further comparative testing against current standards and providing a platform for future integration of agents such as immunotherapy, he concluded.