Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Abstract

Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability (MSI) status, and the expression of programmed death-ligand 1 (PD-L1), has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with localized gastric cancer. This selection from the NCCN Guidelines for Gastric Cancer focuses on the management of unresectable locally advanced, recurrent, or metastatic disease.

Targeting IL8 as a sequential therapy strategy to overcome chemotherapy resistance in advanced gastric cancer

“…Currently, immunotherapies are transforming outcomes for many GC patients and are quickly becoming the fourth pillar of cancer therapy. The latest version of NCCN guidelines for GC has listed nivolumab combined with fluoropyrimidine and oxaliplatin for tumors with PD-L1 expression levels by CPS of ≥5 for HER2 overexpression negative disease as category 1 preferred options for first-line therapy [ 47 ]. Targeting IL8 signaling pathway also exerts broad prospects in immunotherapy of GC.…”

Neoadjuvant Treatment Strategies for Resectable Proximal Gastric, Gastroesophageal Junction and Distal Esophageal Cancer

“…NCCN guidelines recommend endoscopic resection or surgery for Tis-T1b gastric cancer [ 14 ]. Resectable T2+ disease should be offered perioperative chemotherapy (category 1) or preoperative chemoradiation (category 2B) followed by surgery in appropriate candidates [ 14 ].…”

“…NCCN guidelines recommend endoscopic resection or surgery for Tis-T1b gastric cancer [ 14 ]. Resectable T2+ disease should be offered perioperative chemotherapy (category 1) or preoperative chemoradiation (category 2B) followed by surgery in appropriate candidates [ 14 ]. Category 1 recommendations for perioperative chemotherapy include: fluorouracil + leucovorin + oxaliplatin + docetaxel, fluoropyrimidine + oxaliplatin, or fluorouracil + cisplatin [ 14 ].…”

“…Category 1 recommendations for perioperative chemotherapy include: fluorouracil + leucovorin + oxaliplatin + docetaxel, fluoropyrimidine + oxaliplatin, or fluorouracil + cisplatin [ 14 ]. Trastuzumab should be added for HER2 positive adenocarcinoma [ 14 ]. Although preoperative chemoradiation is not preferred, doses for radiation range between 45 and 50.4 Gy [ 14 ].…”

“…Trastuzumab should be added for HER2 positive adenocarcinoma [ 14 ]. Although preoperative chemoradiation is not preferred, doses for radiation range between 45 and 50.4 Gy [ 14 ]. Minor differences exist between NCCN and Japanese guidelines, including the role of neoadjuvant chemotherapy and nodal dissection.…”