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We will await the results of a phase II study of pralatrexate in combination with oxaliplatin in patients with advanced esophagogastric cancer (NCT01178944) to determine any further developemnt of this agent in GE cancers. Acknowledgements Funding: This study was approved and funded by the National Comprehensive Cancer Network (NCCN) Oncology Research Program from general research support provided by Allos Therapeutics Inc./Spectrum Pharmaceuticals. Christina Wu is funded on K12 Faculty Training Grant (CA133250). Disclosure: The authors declare no conflict of interest.""Upfront surgical resection of all gross disease, whether synchronous or staged, is a common practice at many institutions (7). Two primary arguments for this approach are both the concern for the known hepatic toxicity S3I-201 cell line of prolonged courses of cytotoxic chemotherapy, with irinotecan-based regimens, learn more in particular, contributing to the development of chemotherapy-associated steatohepatitis (CASH) and sinusoidal congestion, which increase the risk of complications at the time of liver resection. Another argument is a potential for liver disease progression on systemic chemotherapy and a possibility of losing a window of opportunity to administer a curative R0 resection for patients expressing a more aggressive malignant phenotype or one unresponsive to standard chemotherapy regimens. A level 1 data set on this subject, the EORTC Intergroup trial 40983 randomized 364 patients with colorectal cancer and up to four liver metastases to either six cycles of FOLFOX4 before and six cycles after surgery or to surgery alone. The initial publication (8) with a median follow up of 3.9 years revealed a statistically significant improvement in progression-free survival with the bi-modality approach. Reversible Quinapyramine post-operative complications were higher in the chemotherapy group (25% vs. 16%, P=0.04), while post-operative death was similar in the two arms (1%), and only 1 out of 182 patients in the chemotherapy arm could not undergo resection due to liver damage. Twelve patients (7%) showed progressive disease on chemotherapy, with only 4 of these 12 becoming unresectable due to progression of liver lesions. The long-term results were published last year (9) and revealed no difference in overall survival (51% vs. 48% at 5 years). Two patients in the perioperative chemotherapy group and three in the surgery-only group died from complications of protocol surgery, and one patient in the perioperative chemotherapy group died possibly as a result of toxicity of protocol treatment. The retrospective analysis of EORTC 40983 data suggested a benefit of perioperative chemotherapy in patients with CEA values of >5 ng/mL, good performance score and body mass index