Medical management of gastric cancer: a 2017 update

Abstract

Gastric cancer remains a considerable health burden throughout the world. The Cancer Genome Atlas (TCGA) analysis has recently unveiled 4 genotypes of gastric cancer with data not ready to change treatment strategy yet. A multimodality approach to therapy is the cornerstone of screening, diagnosing, staging, treating and supporting patients with gastric cancer. The evidence‐based approach to localized gastric cancer (>cT1b) is to use an either preoperative or postoperative strategy to maximize the benefit of surgery. The focus of future research is to optimize chemotherapy regimens, determine the role of radiation therapy and investigate the effect of treatment timing. In metastatic gastric cancer, biologic therapies have been introduced targeting markers shown to be prognostic. The results of ongoing randomized controlled phase 3 trials using targeted and immunotherapy agents, either in combination or alone, have the potential to alter the current treatment landscape of advanced gastric cancer.

Tumor immune response and immunotherapy in gastric cancer

“…GC is the fourth most common cancer in the world and the second-leading cause of cancer-associated death [43]. For localized GC, the only curative treatment modality is radical surgery with or without perioperative chemotherapy [44]. For unresectable or metastatic GC, systemic chemotherapy has been the mainstay of palliation.…”

“…For unresectable or metastatic GC, systemic chemotherapy has been the mainstay of palliation. Over the last decade, two new agents, monoclonal antibodies targeting human epidermal growth factor receptor 2 (HER2; trastuzumab) and vascular endothelial growth factor receptor 2 (VEGFR-2; ramucirumab), have been approved by the FDA to treat GC in the palliative setting [44]. Briefly, first-line therapy includes a combination of platinum and fluoropyrimidine (5-fluorouracil or capecitabine) with trastuzumab added in HER2-positive tumors [44].…”

Early detection of gastric cancer after Helicobacter pylori eradication due to endoscopic surveillance

“…Helicobacter pylori infection is one of the most common triggers of gastric cancer, and gastric cancer is the major cause of cancer deaths . Gastric cancers are the third leading cause of cancer mortality and advanced disease carries a dismal prognosis with a 5‐year overall survival rate of less than 5% . Surgery and endoscopic resection at an early stage is still the only chance for cure .…”

In vivo antitumour activity of Britanin against gastric cancer through nuclear factor-κB-mediated immune response

“…Gastric cancer remains a tremendous health burden with a high mortality rate, and surgery is the only complete curative approach . However, poor survival following surgical resection has promoted the use of perioperative chemotherapy and multimodality treatment.…”