Second-line chemotherapy for patients with advanced gastric cancer

Abstract

The first choice for treating patients with metastatic gastric cancer is chemotherapy, and combination therapy with fluorouracil, platinum, and trastuzumab has been established as the standard first-line chemotherapy. For further improvement of treatment outcomes, it is important to develop second- and third-line chemotherapy. In the first decade of this century, irinotecan and taxanes, cytotoxic agents, and various molecular targeted agents began to be developed as second-line therapy. Treatment with paclitaxcel weekly in combination with ramucirumab targeting vascular endothelial growth factor receptor 2 has become the first choice for second-line therapy. Immune checkpoint inhibitors are now being developed, and the current treatment strategies for advanced gastric cancer may undergo major changes in the future. This review summarizes the transitions and future prospects of clinical developments for second-line therapy in patients with advanced gastric cancer.

Apatinib plus S-1 for previously treated, advanced gastric or gastro-oesophageal junction adenocarcinoma: a phase 2, single-arm, prospective study

“…However, compared with paclitaxel, pembrolizumab monotherapy did not significantly improve overall survival for PD-L1 positive advanced gastric or gastro-esophageal junction adenocarcinoma (combined positive score [CPS] of 1 or higher). With reference to other second-line chemotherapy regimens [20,24], the median PFS and median OS in patients using apatinib plus S-1 in this study were comparable to the existing studies, and had advantages in the form of convenience and mild adverse reactions. It is believed that the combination of apatinib and S-1 would have a better performance after dose adjustment and toxicity management.…”

Transmembrane protein GRINA modulates aerobic glycolysis and promotes tumor progression in gastric cancer

“…Recently, therapies targeting human epidermal growth factor receptor-2 (HER-2), epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and so on, have provided gastric cancer patients with better survival rates [32, 33]. Trastuzumab and ramucirumab have produced in modest improvements in OS for patients with HER-2 positive gastric cancer and in the second-line setting, respectively [34]. Even so, studies on more effective and selective targeted drugs need to be undertaken.…”

Targeted and novel therapy in advanced gastric cancer

“…Cytotoxic chemotherapy remains the backbone of systemic treatment; platinum- and fluoropyrimidine-based combination therapy is used as the preferred first-line treatment of advanced GC. After first-line therapy, randomized trials of single-agent cytotoxic chemotherapy such irinotecan, paclitaxel and docetaxel have demonstrated improved overall survival (OS) and quality of life when compared with best supportive care [3]. In USA, there has been a significant reduction in inpatient GC mortality which is consistent with overall decrease in GC-related deaths [4].…”