Present status and perspective of chemotherapy for patients with unresectable advanced or metastatic gastric cancer in Japan

Abstract

Patients with unresectable advanced or recurrent gastric cancer have a poor prognosis with overall survival times increasing by only a few months after anti-cancer drug therapy in the last four decades. The survival times from previous clinical trials for untreated metastatic gastric cancer in Japan are generally better than those reported from trials in European and North or South American countries. Therefore, the proportion of Japanese patients enrolled in recent global trials of novel anti-cancer drugs should be increased in order to identify drugs that specifically prolong the survival of such patients. S-1 plus oxaliplatin (SOX) therapy is the most commonly used standard first-line treatment for advanced gastric cancer in Japan. SOX induces mild nausea and vomiting, even in elderly patients, that can be treated by maintaining oral intake with adequate anti-emetic treatment usually given in an outpatient clinic. Neutropenia, nausea, and vomiting in SOX therapy were more frequently observed in female patients compared with males. Intensive toxic chemotherapy such as triplet therapy never prolonged overall survival or maintained a favorable quality of life. The current strategies used against metastatic gastric cancer need to be modified in regard to innovative treatments with current drugs, keeping in mind each categorized treatment population. In a real world of a diverse society even if the same treatment is performed, the outcome of the individual patient is different. It is important for each society to implement established treatment, knowing that the evidence from global trials aimed at drug approval does not necessarily show external validity.

Global retrospective analysis of clinician- and patient-reported clinical characteristics and humanistic burden of patients with gastroesophageal cancers on first-line treatment

“…While these differences were not statistically significant, in four out of five questions, when the individual effects of the dimensions were analyzed together, they may have led to the positive coefficient of recurrent cancer we found. In a healthcare system that includes medical environment, culture, sex, and comorbidities, even if the same treatment is available, the outcome in the individual patient is different [37]. In our study, the FACT-Ga, which combines the FACT-G with a 19-item gastric cancer subscale, showed significant impairment in HRQoL in patients with GC/GEJC/EAC compared to the general population.…”

Claudin18.2 in Advanced Gastric Cancer

“…Gastric cancer (GC) is the fifth most common cancer and the fourth cause of cancerrelated mortality globally [1]. For a long time, the mainstay of treatment for advanced unresectable or metastatic GC is conventional cytotoxic agents [2]. However, with the advent of molecular-targeted therapies, trastuzumab, a human epidermal growth factor receptor 2 (HER2) targeting monoclonal antibody (mAb), became the first-line treatment for HER2-positive GC [3]; moreover, as second-line treatment, ramucirumab, a vascular endothelial growth factor receptor 2-targeting mAb, also showed survival benefit when combined with paclitaxel [4].…”

Clinical Study of Sintilimab as Second-Line or Above Therapy in Patients With Advanced or Metastatic Gastric Cancer: A Retrospective Study

“…Medical treatment, including chemotherapy and targeted therapy, is currently the main treatment for advanced or metastatic gastric cancer. However, the efficacy of chemotherapy drugs seems to have reached a plateau, and the progress of traditional targeted therapy drugs is relatively slow ( 3 , 4 ). As an emerging treatment method, immunotherapy is the current research hotspot, and it is hoped that it can further improve the curative effect of advanced gastric cancer ( 5 ).…”