# CLASSIC: adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy

Source: https://onco.cc/key-papers/paper-classic-adjuvant-capox-gastric-bang-lancet-2012/  
OnCo record `paper-classic-adjuvant-capox-gastric-bang-lancet-2012` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Six months of capecitabine and oxaliplatin after a D2 gastrectomy raised three-year disease-free survival from 59 to 74 percent in East Asian patients with stage II to III stomach cancer.

## Summary

Open-label phase 3 trial at 37 centres in South Korea, China and Taiwan: 1,035 patients with stage II to IIIB gastric cancer after curative D2 gastrectomy were randomised to eight cycles of capecitabine and oxaliplatin (520) or observation (515).

Three-year disease-free survival was 74 percent with chemotherapy against 59 percent with surgery alone (hazard ratio 0.56). Grade 3 or 4 adverse events occurred in 56 percent of chemotherapy patients against 6 percent of surgery-only patients, most commonly nausea, neutropenia and decreased appetite.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet
- Year: 2012
- DOI: 10.1016/S0140-6736(11)61873-4
- Authors: Bang YJ, Kim YW, Yang HK, et al.
- Findings: Three-year disease-free survival 74 percent (95% CI 69 to 79) versus 59 percent (53 to 64); hazard ratio 0.56 (0.44 to 0.72), p < 0.0001.; Grade 3 or 4 adverse events 56 percent versus 6 percent.
- What it means: Adjuvant CAPOX after D2 gastrectomy is a standard option for operable stage II to III gastric cancer, alongside S-1 in Japan.
- Caveats: East Asian population with D2 surgery; Western practice relies on perioperative chemotherapy (FLOT) instead.; Open-label design.

## Sources

- Lancet 2012: https://doi.org/10.1016/S0140-6736(11)61873-4
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22226517/

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/)
- trials: [CLASSIC](https://onco.cc/trials/classic/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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