Upper GI: MAGIC trial - perioperative chemotherapy principle

Why A is correct

The MAGIC trial randomised patients with resectable gastric, gastro-oesophageal junction or lower oesophageal adenocarcinoma to perioperative ECF (three preoperative and three postoperative cycles) plus surgery, or surgery alone, improving 5-year overall survival to about 36% versus 23% (HR for death 0.75; p=0.009). This established perioperative chemotherapy as a standard of care, later superseded by FLOT.

And why the others are not

• BThe FLOT-versus-ECF comparison is the FLOT4 trial, not MAGIC.
• CMAGIC tested perioperative chemotherapy, not postoperative chemoradiotherapy; the latter is the design of the US Intergroup INT-0116 trial.
• DTrastuzumab in HER2-positive gastric cancer was tested in the ToGA trial in the metastatic setting, not in MAGIC.
• ENeoadjuvant chemoradiotherapy versus surgery alone, including squamous cell carcinoma, is the CROSS design, not MAGIC.

Source MAGIC - Perioperative ECF chemotherapy versus surgery alone in resectable gastro-oesophageal adenocarcinoma — Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20.