Chemotherapy in the Treatment of Metastatic Gastric Cancer: Is There a Global Standard?

Abstract

Gastric cancer remains one of the leading causes of cancer mortality worldwide even though its incidence has been decreasing in recent years. Despite remarkable advancements in chemotherapy, advanced gastric cancer has remained a therapeutic challenge for physicians as well as for patients. While early chemotherapeutic regimens succeeded in showing a modest but definite improvement over best supportive care, no single regimen stood out as superior. Most early trials failed to show survival benefit of combination regimens over single agent fluorouracil, but combination regimens were shown to have better response rates. Based on these data, the Japanese adopted single agent fluorouracil as a reference standard for further investigations, while the rest of the world used a doublet containing fluorouracil and platinum. As more clinical trials were conducted, the Japanese standard evolved into a doublet, while the Western countries adopted triplet combinations. There is no established global standard as yet, but with the introduction of newer targeted agents based on molecular assays and personalized approaches combined with conventional chemotherapy, multiple regimens are likely to emerge as global standards rather than one standard treatment for all.

Assessment of HER2 status in patients with gastroesophageal adenocarcinoma treated with epirubicin-based chemotherapy: heterogeneity-related issues and prognostic implications

“…In 88 patients, two blocks obtained from the same resection specimen were retrieved, and for 76 of them, a third additional block was also available. Per patient, the median number of biopsy fragments retrieved was five (range [1][2][3][4][5][6][7][8].…”

“…Whereas alternative non-anthracycline regimens have been successfully evaluated [2], a perioperative approach with ECF is still a standard of care in most European countries for treatment of resectable disease. Additionally, despite the lack of a global standard [3], use of anthracyclines is supported by a meta-analysis highlighting significant survival advantages with anthracycline-containing triplets in a palliative setting [4]. As a result, regimens such as ECF (or ECF modifications) are recommended by current European and North American guidelines for both resectable and first-line settings [5][6][7].…”

Quantitative Measurement of Organic Acids in Tissues from Gastric Cancer Patients Indicates Increased Glucose Metabolism in Gastric Cancer

“…Many patients with gastric cancer are diagnosed at an advanced stage, and they have a high rate of recurrence after curative resection and a poor response to treatment [2], [3]. To improve the survival rate of gastric cancer, efforts have focused on the identification of patients with poor prognosis and new therapeutic modalities based on molecular mechanisms [4].…”

Advances in the Management of HER2-positive Advanced Gastric and Gastroesophageal Junction Cancer

“…8,9 Objective response rates of 30% to 60% have been observed for combination chemotherapy regimens versus 10% to 30% for single agents. [10][11][12] Agents that are active in gastric cancer include fluoropyrimidines such as 5-fluorouracil (5-FU), capecitabine, and S-1; anthracyclines such as epirubicin or doxorubicin; taxanes such as docetaxel and paclitaxel; the topoisomerase I inhibitor irinotecan; and platinum analogs such as cisplatin and oxaliplatin. Combinations of fluoropyrimidines and platinum agents are the most widely used regimens.…”