What adjuvant therapy would be recommended for node positive gastric adenocarcinoma s/p gastrectomy, in a patient who did not receive neoadjuvant therapy?

The 4 studies that provide guidance for adjuvant treatment are chemotherapy only (ACTS-GC and CLASSIC with 1 year of S-1 and Capeox respectively)chemoradiation (US INT 116 for bolus 5-FU/leucovorin before and after chemoradiation with 5-FU) and chemotherapy with or without chemoradiation (ARTIST study).

For a patient who is fit, I typically consider FOLFOX ( as an extrapolation of the Capeox used in the CLASSIC study, given poor tolerance of capecitabine in U.S. patients) for up to 6 months. A f...