Adjuvant Therapy in Gastric Cancer

2005 ◽  
Vol 23 (25) ◽  
pp. 6220-6232 ◽  
Author(s):  
Lionel Lim ◽  
Michael Michael ◽  
G. Bruce Mann ◽  
Trevor Leong
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Standard Of Care ◽  
Current Status ◽  
Research Directions ◽  
Treatment Delivery ◽  
Significant Survival ◽  
Definitive Surgery ◽  
Radiation Planning

Gastric cancer has a poor prognosis. The majority of patients will relapse after definitive surgery, and 5-year survival after surgery remains poor. The role of adjuvant therapy in gastric cancer has been controversial given the lack of significant survival benefit in many randomized studies so far. The results of a large North American study (Gastrointestinal Cancer Intergroup Trial INT 0116) reported that postoperative chemoradiotherapy conferred a survival advantage compared with surgery alone, which has led to the regimen being adopted as a new standard of care. However, controversies still remain regarding surgical technique, the place of more effective and less toxic chemotherapy regimens, and the use of more modern radiation planning techniques to improve treatment delivery and outcome in the adjuvant and neoadjuvant setting. This article reviews the current status of the adjuvant treatment for gastric cancer including discussion on the research directions aimed at optimizing treatment efficacy. Issues such as the identification of patients who are more likely to benefit from adjuvant therapy are also addressed. Further clinical trials are needed to move towards better consensus and standardization of care.

Adjuvant Treatments for Localized Advanced Gastric Cancer: Differences among Geographic Regions

2012 ◽  
pp. e31-e34
Author(s):  
Yoon-Koo Kang ◽  
Changhoon Yoo
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Standard Of Care ◽  
Current Standard ◽  
The West ◽  
The United Kingdom ◽  
Group B ◽  
Leukemia Group ◽  
Postoperative Chemoradiation

Overview: After much debate, adjuvant therapy has become the standard of care worldwide for resected localized gastric cancer. However, geographic differences exist in standard adjuvant treatments: postoperative chemoradiation in North America, perioperative chemotherapy in the United Kingdom, and postoperative chemotherapy in East Asia. Now that D2 gastrectomy has been recognized as the optimal surgery for localized gastric cancer in the West as well as in Asia, the standard adjuvant treatments used in the West may need to be reconsidered. One of the most important issues in adjuvant therapy for localized gastric cancer is how to improve the clinical outcomes of current standard treatments. Recent Cancer and Leukemia Group B (CALGB) and AMC studies suggest that simply intensifying chemotherapy by adding more agents or prolonging treatment duration is insufficient. However, new strategies like early initiation of chemotherapy and/or intraperitoneal chemotherapy may further improve the current standard adjuvant therapy. In the era of targeted therapy, the role of biologic agents for gastric cancer should also be explored in the adjuvant setting. With a deeper understanding of the molecular biology of gastric cancer, adjuvant therapy for patients with localized gastric cancer can be optimized and individualized.

scholarly journals Molecular Targets for Gastric Cancer Treatment and Future Perspectives from a Clinical and Translational Point of View

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5216
Author(s):  
Justus Körfer ◽  
Florian Lordick ◽  
Ulrich T. Hacker
Keyword(s):  
Gastric Cancer ◽  
Targeted Therapy ◽  
Molecular Characterization ◽  
Gastroesophageal Junction ◽  
Standard Of Care ◽  
Metastatic Gastric Cancer ◽  
Point Of View ◽  
Current Status ◽  
Molecular Alterations ◽  
Definition Of

Gastric cancer is a leading cause of cancer death worldwide. Systemic treatment comprising chemotherapy and targeted therapy is the standard of care in advanced/metastatic gastric cancer. Comprehensive molecular characterization of gastric adenocarcinomas by the TCGA Consortium and ACRG has resulted in the definition of distinct molecular subtypes. These efforts have in parallel built a basis for the development of novel molecularly stratified treatment approaches. Based on this molecular characterization, an increasing number of specific genomic alterations can potentially serve as treatment targets. Consequently, the development of promising compounds is ongoing. In this review, key molecular alterations in gastric and gastroesophageal junction cancers will be addressed. Finally, the current status of the translation of targeted therapy towards clinical applications will be reviewed.

scholarly journals Towards Personalization in the Curative Treatment of Gastric Cancer

2020 ◽  
Vol 10 ◽  
Author(s):  
Astrid E. Slagter ◽  
Marieke A. Vollebergh ◽  
Edwin P. M. Jansen ◽  
Johanna W. van Sandick ◽  
Annemieke Cats ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Molecular Characteristics ◽  
Perioperative Chemotherapy ◽  
Current Standard ◽  
Common Cancer ◽  
Resectable Gastric Cancer

Gastric cancer is the fifth most common cancer worldwide and has a high mortality rate. In the last decades, treatment strategy has shifted from an exclusive surgical approach to a multidisciplinary strategy. Treatment options for patients with resectable gastric cancer as recommended by different worldwide guidelines, include perioperative chemotherapy, pre- or postoperative chemoradiotherapy and postoperative chemotherapy. Although gastric cancer is a heterogeneous disease with respect to patient-, tumor-, and molecular characteristics, the current standard of care is still according to a one-size-fits-all approach. In this review, we discuss the background of the different treatment strategies in resectable gastric cancer including the current standard, the specific role of radiotherapy, and describe the current areas of research and potential strategies for personalization of therapy.

TOPGEAR: An international randomized phase III trial of preoperative chemoradiotherapy versus preoperative chemotherapy for resectable gastric cancer (AGITG/TROG/EORTC/NCIC CTG).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS4141-TPS4141 ◽  
Author(s):  
Trevor Leong ◽  
Mark Smithers ◽  
Michael Michael ◽  
Val Gebski ◽  
Alex Boussioutas ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Phase Ii ◽  
Preoperative Chemotherapy ◽  
Gastroesophageal Junction ◽  
Phase Iii ◽  
Standards Of Care ◽  
Current Status ◽  
Quality Assurance Program ◽  
Resectable Gastric Cancer

TPS4141 Background: Optimal management of patients with resectable gastric cancer remains unknown. Since the INT0116 and MAGIC trials, there are 2 standards of care for adjuvant therapy: postoperative chemoradiotherapy (CRT) and perioperative ECF chemotherapy. The important question arising from these studies is whether CRT is superior to chemotherapy alone as adjuvant therapy. This randomized phase II/III trial will compare CRT to chemotherapy alone in the preoperative setting. Methods: Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either preoperative chemotherapy alone (ECFx3 as per MAGIC regimen) or preoperative CRT (ECFx2 followed by 45Gy of radiation with concurrent 5-FU). Following surgery, both groups will receive 3 further cycles of ECF. The trial is being conducted in two Parts; Part I (phase II component) will recruit 120 patients with the aim of demonstrating sufficient efficacy and safety of preoperative CRT, as well as trial feasibility. Part II (phase III component) will recruit a further 632 patients to provide a total of 752. The primary endpoint for Part I is pathological complete response rate, and for Part 2 it is overall survival. The trial includes formal quality of life and biological sub-studies. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of surgical technique. Current status: This study is an international, intergroup trial led by the Australasian Gastro-Intestinal Trials Group (AGITG), in collaboration with the Trans-Tasman Radiation Oncology Group (TROG), European Organisation for Research and Treatment of Cancer (EORTC) and the NCIC Clinical Trials Group. To date, 36 patients have been recruited from 20 sites in Australia and New Zealand; European and Canadian sites will commence recruitment in 2012.

scholarly journals The Role of MicroRNAs in the Regulation of Gastric Cancer Stem Cells: A Meta-Analysis of the Current Status

2019 ◽  
Vol 8 (5) ◽  
pp. 639 ◽  
Author(s):  
Vitalba Ruggieri ◽  
Sabino Russi ◽  
Pietro Zoppoli ◽  
Francesco La Rocca ◽  
Tiziana Angrisano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stem Cells ◽  
Cancer Stem Cells ◽  
Meta Analysis ◽  
Current Status ◽  
Cancer Drug ◽  
Cellular Processes ◽  
Cancer Drug Resistance ◽  
Gastric Cancer Stem Cells

Gastric cancer (GC) remains one of the major causes of cancer-related mortality worldwide. As for other types of cancers, several limitations to the success of current therapeutic GC treatments may be due to cancer drug resistance that leads to tumor recurrence and metastasis. Increasing evidence suggests that cancer stem cells (CSCs) are among the major causative factors of cancer treatment failure. The research of molecular CSC mechanisms and the regulation of their properties have been intensively studied. To date, molecular gastric cancer stem cell (GCSC) characterization remains largely incomplete. Among the GCSC-targeting approaches to overcome tumor progression, recent studies have focused their attention on microRNA (miRNA). The miRNAs are short non-coding RNAs which play an important role in the regulation of numerous cellular processes through the modulation of their target gene expression. In this review, we summarize and discuss recent findings on the role of miRNAs in GCSC regulation. In addition, we perform a meta-analysis aimed to identify novel miRNAs involved in GCSC homeostasis.

scholarly journals ‘All action no talk’: the role of HER2/neu in adjuvant therapy choice for gastric cancer

2013 ◽  
Vol 24 (7) ◽  
pp. 1715-1717 ◽  
Author(s):  
D. Santini ◽  
B. Vincenzi ◽  
F. Pantano ◽  
G. Schiavon ◽  
G. Tonini
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Therapy Choice

scholarly journals The Multifaceted Role of Long Non-Coding RNA in Gastric Cancer: Current Status and Future Perspectives

2021 ◽  
Vol 17 (11) ◽  
pp. 2737-2755
Author(s):  
Yifan Li ◽  
Lan Lu ◽  
Xu Wu ◽  
Qianxiu Li ◽  
Yueshui Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Current Status ◽  
Future Perspectives ◽  
Non Coding Rna ◽  
Long Non Coding Rna

Controversies in the Surgical Management of Gastric Cancer

2003 ◽  
Vol 1 (1) ◽  
pp. 115-124 ◽  
Author(s):  
David A. Kooby ◽  
Daniel G. Coit
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Adjuvant Therapy ◽  
The United States ◽  
Lymph Node Staging ◽  
Extended Lymph Node Dissection ◽  
Current State ◽  
Complete Surgical Resection ◽  
Considerable Controversy

Although the incidence of gastric adenocarcinoma in the United States has declined steadily since the early 1900s, it remains a significant health problem. Progress has been made during the past few decades in several areas: Lymph node staging has been refined, perioperative mortality has fallen, and plausible adjuvant therapy has emerged. Currently, complete surgical resection is the mainstay of therapy because it is the only potentially curative option; however, considerable controversy remains regarding the specifics of a surgical approach. This article examines 4 major controversies in the management of gastric cancer: extent of gastric resection, role of extended lymph node dissection, value of elective splenectomy for proximal gastric lesions, and current state of adjuvant therapy. Pertinent retrospective and prospective studies are reviewed to help formulate meaningful conclusions.

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