Second-line chemotherapy for advanced gastric cancer in Korea

Abstract

Stomach cancer is still one of the most prevalent malignancies and is the main cause of cancer deaths worldwide. The outcome for patients with metastasis, as well as for those with tumor recurrence, is dismal, with median survival time not greater than a year. Patients with unresectable locally advanced or metastatic lesions have been treated with systemic chemotherapy, and several randomized studies have demonstrated the benefit of chemotherapy compared with best supportive care. Recently, randomized phase III trials have presented a benefit of second-line chemotherapy compared with supportive care alone. However, it is not known at present which drug is the most effective in this setting. In Korea, the practice of offering second-line treatment to patients with advanced gastric cancer (AGC) is common, and many prospective clinical trials investigating clinical outcomes of second-line chemotherapy have been reported. Therefore, to define the potential role of second-line chemotherapy and to help to select an effective regimen, we review the published Korean prospective data concerning the use of chemotherapy in the second-line setting for the treatment of AGC. No phase III trials but 20 phase II trials were identified. The benefit of second-line chemotherapy in AGC has indirect evidence considering prolongation of progression-free survival (PFS) and improvement of the response rate. Taxanes, irinotecan, and oxaliplatin have been studied much and might be promising drugs considering crossresistance to a 5-fluorouracil and cisplatin combination (FP). A large, prospective, multicenter, randomized phase III study is warranted to select the most effective second-line chemotherapeutic agents.

Berberine Improves Chemo-Sensitivity to Cisplatin by Enhancing Cell Apoptosis and Repressing PI3K/AKT/mTOR Signaling Pathway in Gastric Cancer

“…Cisplatin (DDP) as a chemotherapeutic reagent has been widely used in the treatment for gastric cancer, and DDP-based therapy could significantly improve the survival of patients with gastric cancer (Wagner et al, 2017). Unfortunately, metastasis and recurrence of the gastric cancer are commonly existing in the patients due to the acquired and intrinsic DDP resistance (Haller and Misset, 2002;Baek et al, 2012;Choi et al, 2017). As DDP is still the standard chemotherapy for gastric cancer, developing effective way to reduce the DDP-resistance in gastric cancer is of great clinical significance.…”

Pemetrexed for previously treated patients with metastatic gastric cancer: a prospective phase II study

“…But when compared with other second-line chemotherapy regimens, pemetrexed achieved a comparable activity. The common second-line regimens, commonly based on taxanes, iritecan, platinum and 5-FU, administered in combination or as single agent, produced a median OS of about 5–13 months, median PFS of about 2–4 months and ORR of about 5–30% ( Wesolowski et al , 2009 ; Baek et al , 2012 ). Despite the difference in regimens, the activity might also be influenced by some potential prognostic factors, including time to progression on first-line treatment, serum albumin, performance status and chemotherapy-free interval.…”

LINC00641/miR-582-5p mediate oxaliplatin resistance by activating autophagy in gastric adenocarcinoma

“…In gastric carcinoma, oxaliplatin (L-OHP) is one of the most important anti-cancer agents 3 . However, L-OHP resistance frequently occurs during treatment and significantly limits the efficacy of L-OHP 4 . In this context, it is necessary to investigate the molecular mechanisms of L-OHP resistance in gastric adenocarcinoma, and identify effective therapeutic targets.…”