Methodological clarifications on maintenance fluoropyrimidines in advanced esophagogastric adenocarcinoma: a real-world Mexican cohort
We thank Dr. Naveed and Feroz for their thoughtful comments (1) and for their interest in our work evaluating maintenance therapy in patients with advanced gastric cancer treated in a real-world, non-Asian population (2). We appreciate the opportunity to clarify several methodological aspects and to further contextualize our findings.
Selection of patients achieving disease control
As correctly noted, our analysis included patients who achieved disease control (complete response, partial response, or stable disease) after first-line therapy. This selection was intentional and clinically driven, as maintenance therapy is, by definition, only applicable to patients who do not experience primary disease progression after induction treatment. Consequently, our results are not intended to represent the entire first-line population, but rather the subgroup of patients eligible for maintenance strategies.
We acknowledge that this approach limits generalizability to patients with early progression; however, it appropriately reflects real-world clinical decision-making. Importantly, survival outcomes were analyzed within this predefined population, and conclusions were framed accordingly. This limitation has been explicitly acknowledged in the manuscript.
Heterogeneity of first-line treatment regimens
We agree that heterogeneity in first-line regimens is an inherent limitation of retrospective, real-world studies. Nevertheless, this heterogeneity also reflects routine clinical practice, particularly in regions where treatment selection is influenced by patient characteristics, toxicity profiles, and resource availability.
Single-center design
We acknowledge that the single-center nature of our study may limit extrapolation to other institutions or regions. However, this design also ensured consistency in diagnostic criteria, treatment delivery, follow-up, and outcome assessment. Moreover, data from Latin American populations remain underrepresented in gastric cancer research, and our study contributes valuable real-world evidence from a non-Asian cohort. We agree that multicenter validation would be desirable and represents an important direction for future research.
For any additional information, I remain at your disposal.
Acknowledgments
None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Gastrointestinal Oncology. The article did not undergo external peer review.
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-2026-1-0093/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Naveed H, Feroz M. Impact of maintenance therapy with fluoropyrimidines in advanced esophageal-gastric adenocarcinoma: a critical review. J Gastrointest Oncol 2026; [Crossref]
- Dip Borunda AK, Pimentel Rentería A, Medrano Guzmán R, et al. Impact of maintenance therapy with fluoropyrimidines in advanced esophageal-gastric adenocarcinoma: a retrospective study in Mexican population. J Gastrointest Oncol 2025;16:1812-9.
