Systemic Therapy for Advanced Gastric Cancer: A Clinical Practice Guideline

Abstract

• Within a combination chemotherapy regimen, oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)-that is, epirubicin-cisplatincapecitabine is preferred over the prior standard regimen, epirubicin-cisplatin-5fu (ecf).• Epirubicin-oxaliplatin-capecitabine (eox) is a reasonable alternative to ecf. The choice between ecf and eox should be based on patient preference.• Trastuzumab in combination with cisplatin and a fluoropyrimidine (5fu or oral capecitabine) is recommended for advanced gastric cancer positive for the human epidermal growth factor receptor 2 (her2/neu). KEY WORDSAdvanced gastric cancer, systemic therapy, practice guideline QUESTIONWhat is the optimal chemotherapy regimen in advanced gastric cancer? Outcomes of interest were overall survival (os), objective response rate (complete plus partial responses), time to disease progression, adverse effects, and quality of life. INTRODUCTIONGastric cancer is a virulent disease that is the second leading cause of cancer mortality worldwide 1 . There is significant geographic variation in the incidence of gastric cancer, with incidence and mortality being particularly high in Japan, China, Korea, Chile, and Costa Rica 2 . Even though the incidence rate for gastric cancer in Ontario is one of the lowest worldwide 3 , overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada 4 and 23%-25% in the United States for all stages combined 5 .Despite the considerable body of research available on chemotherapy for advanced gastric cancer, ABSTRACT QuestionWhat is the optimal chemotherapy regimen in advanced gastric cancer? PerspectivesGastric cancer is the second leading cause of cancer mortality worldwide. Despite low incidence rates for gastric cancer in Ontario, the overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada. Even with the considerable body of research available on chemotherapy for advanced gastric cancer, uncertainty remains. There is no recognized standard treatment, and there appears to be geographic variation in practice. OutcomesOutcomes of interest were overall survival, objective response rate (complete plus partial responses), time to disease progression, adverse effects, and quality of life. MethodologyAfter a systematic review, a practice guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice guideline was reviewed and approved by the Gastrointestinal Disease Site Group (gi dsg) and the Report Approval Panel of the Program in Evidence-Based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice guideline. Practice GuidelineThe gi dsg makes the following recommendations:• To improve survival, a platinum agent should be included in any combination chemotherapy regimen.

Peripheral venous blood neutrophil-to-lymphocyte ratio predicts survival in patients with advanced gastric cancer treated with neoadjuvant chemotherapy

“…The latest publication data from the World Health Organization (WHO) and International Arctic Research Center (IARC) indicate that the incidence of gastric cancer is 952,000 worldwide and 405,000 in China, accounting for 42.6% of the global incidence 3. In China, most of the patients are diagnosed in advanced stages of gastric carcinoma, ~10% patients are at the early stage of gastric cancer, and the 5-year survival rate is 10%–30% 4. Gastric resection with D2 lymph node dissection is the mainstay of treatment in advanced gastric carcinoma.…”

Clinical Practice Recommendations for the Management and Prevention of Cisplatin-Induced Hearing Loss Using Pharmacogenetic Markers

“…Oxaliplatin however, has been investigated as an alternative to cisplatin in some tumour types. For example, oxaliplatin-based regimens have been recommended as an alternative to cisplatin-based therapy for the treatment of advanced gastric cancer 58 . Studies have also reported comparable outcomes to cisplatin-based therapy with reduced toxicity for advanced non-small-cell lung cancer 59 .…”

The Relative Efficacies and Developments in Adjuvant and Neoadjuvant Therapy for Gastric Cancer - Review

“…MacKenzie [32] and the Gastrointestinal Cancer Disease Site Group (2011)sought to determine the optimal chemotherapy for gastric cancer in its advanced stages. The study came up with various recommendations, which included the following.…”