Overview of Chemotherapy for Gastric Cancer

Abstract

Gastric cancer (GC) is one of the most clinically challenging cancers worldwide. Over the past few years, new molecular-targeted agents and immunotherapy have markedly improved GC prognosis. Human epidermal growth factor receptor 2 (HER2) expression is a key biomarker in first-line chemotherapy for unresectable advanced GC. Further, the addition of trastuzumab to cytotoxic chemotherapy has extended the overall survival of patients with HER2-positive advanced GC. In HER2-negative GC, the combination of nivolumab, an immune checkpoint inhibitor, and a cytotoxic agent has been demonstrated to prolong the overall survival of GC patients. Ramucirumab and trifluridine/tipiracil, which are second- and third-line treatments for GC, and trastuzumab deruxtecan, an antibody–drug conjugate for HER2-positive GC, have been introduced in clinics. New promising molecular-targeted agents are also being developed, and combination therapy comprising immunotherapy and molecular-targeted agents is expected. As the number of available drugs increases, it is important to understand the target biomarkers and drug characteristics and select the optimal therapy for each patient. For resectable disease, differences in the extent of standard lymphadenectomy between Eastern and Western countries have led to different standard treatments: perioperative (neoadjuvant) and adjuvant therapy. This review aimed to summarize recent advances in chemotherapy for advanced GC.

Prognostic Factors and the Role of Adjuvant Chemotherapy in Pathological Node-Negative T3 Gastric Cancer

“…In the era of precision or individualized medicine, tailored treatment strategies for GC patients are preferred, according to disease severity and clinicopathological characteristics, patients’ will, individuals’ general performance and comorbidities, as well as the potential benefits and disadvantages of the use of adjuvant treatment. Other advanced or modern molecular biomarkers have been increasingly adopted to select the right patients for targeted therapy or immunotherapy [ 7 , 10 , 11 ]. Nonetheless, few patients are indicated for or can afford these treatments, due to low rates of HER-2 positivity or financial toxicity [ 12 ].…”

“…Nonetheless, it remains unclear whether the subgroup of patients with T3N0M0 would benefit from fluoropyrimidine-based chemotherapy, since these studies did not recruit patients with pT3N0M0 (Japanese guidelines do not recommend adjuvant chemotherapy for those patients) [ 18 , 19 , 20 , 21 ]. However, the guidelines of National Comprehensive Cancer Network/Europe and substantial evidence suggest that Stage II and III patients should undergo adjuvant chemotherapy, chemoradiotherapy or perioperative chemotherapy [ 7 , 11 , 22 , 23 ]. Our results demonstrate that chemotherapy did not confer survival benefit to pT3N0M0 patients.…”

Immunotherapy of gastric cancer: Present status and future perspectives

“…Avelumab is a fully humanized PD-L1 IgG1 monoclonal antibody which, by binding to PD-L1, reduces the level of immunosuppression by blocking the reaction between PD-L1 and the PD-1 receptor[ 55 ]. The drug administered alone or as part of a combination therapy demonstrates satisfactory clinical results possibly in subsequent therapies;…”

Applications of peptide-based nanomaterials in targeting cancer therapy

“…As is known, malignant tumors arise from the loss of normal regulation and excessive proliferation of cells, making them one of the leading causes of death in the world. Although some conventional methods have been put into clinical use, such as chemotherapy 2 and radiotherapy, 3 the systemic toxicity and side effects limit their application. Chemotherapy is a treatment that kills cells rapidly through drug molecules.…”