Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy

2016 ◽  
Vol 25 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Kunihiko Izuishi ◽  
Hirohito Mori
Keyword(s):  
Gastric Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy ◽  
Advanced Tumor ◽  
Esophagogastric Cancer ◽  
Previously Treated

Recently, many strategies have been reported for the effective treatment of gastric cancer. However, the strategy for treating stage IV gastric cancer remains controversial. Conducting a prospective phase III study in stage IV cancer patients is difficult because of heterogeneous performance status, age, and degree of cancer metastasis or extension. Due to poor prognosis, the variance in physical status, and severe symptoms, it is important to determine the optimal strategy for treating each individual stage IV patient. In the past decade, many reports have addressed topics related to stage IV gastric cancer: the 7th Union for International Cancer Control (UICC) TNM staging system has altered its stage IV classification; new chemotherapy regimens have been developed through the randomized ECF for advanced and locally advanced esophagogastric cancer (REAL)-II, S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer (SPIRITS), trastuzumab for gastric cancer (ToGA), ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD), and ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW) trials; and the survival efficacy of palliative gastrectomy has been denied by the reductive gastrectomy for advanced tumor in three Asian countries (REGATTA) trial. Current strategies for treating stage IV patients can be roughly divided into the following five categories: palliative gastrectomy, chemotherapy, radiotherapy, gastric stent, or bypass. In this article, we review recent publications and guidelines along with above categories in the light of individual symptoms and prognosis. Abbreviations: APC: argon plasma coagulation; AVAGAST: anti-angiogenic antibody bevacizumab, the avastin in gastric cancer; BSC: best supportive care; CF: cisplatin and fluorouracil; CRP: C-reactive protein; DCF: docetaxel, cisplatin, and 5-FU; FISH: fluorescent in-situ hybridization; GJ: gastrojejunostomy; GPS: Glasgow Prognostic Score; HER: human epidermal growth factor receptor; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; OS: overall survival; PS: performance status; QOL: quality of life; RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; RCTs: randomized controlled trials; REAL: randomized ECF for advanced and locally advanced esophagogastric cancer; REGARD: ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; REGATTA: reductive gastrectomy for advanced tumor in three Asian countries; SEER: Surveillance Epidemiology and End Results; SEMS: self-expandable metal stents; SPIRITS: S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer; ToGA: trastuzumab for gastric cancer; TTP: time-to-progression; VEGFR: vascular endothelial growth factor receptor.

SPan-1 Is a Useful Prognostic Marker for Patients with Stage IV Gastric Cancer Who Underwent Palliative Gastrectomy: A Retrospective Multivariate Study

2013 ◽  
Vol 37 (7) ◽  
pp. 1681-1687
Author(s):  
Naoshi Kubo ◽  
Masaichi Ohira ◽  
Katsunobu Sakurai ◽  
Takahiro Toyokawa ◽  
Hiroaki Tanaka ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Marker ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy ◽  
Multivariate Study

Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

2005 ◽  
Vol 30 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Reza F. Saidi ◽  
Stephen G. ReMine ◽  
Paul S. Dudrick ◽  
Nader N. Hanna
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy

Clinical outcome of sequential chemotherapy in metastatic and/or recurrent gastric cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15521-e15521
Author(s):  
Y. Moon ◽  
S. Rha ◽  
H. Jeung ◽  
S. Shin ◽  
N. Yoo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Natural History ◽  
Performance Status ◽  
Stage Iv ◽  
Poor Performance ◽  
Median Number ◽  
Care Group ◽  
Metastatic Site ◽  
Stage Iv Gastric Cancer ◽  
History Of

e15521 Background: Little is known about data on subsequent chemotherapy (CTx) following 1st-line CTx in stage IV gastric cancer. The purpose of this study was to analyze the natural history of stage IV gastric cancer with sequential CTx Methods: A total of 532 patients (pts) with unresectable gastric adenocarcinoma were studied. They were managed with a strategy of maximal administration of CTx only if pts’ general conditions were allowed. Response evaluation was performed by RECIST every 2 cycles. Response of unmeasurable lesions was dichotomized only into stable disease or progressive disease. Results: When pts were divided into CTx group (460 of 532, 87%) and best supportive care group (BSC; 72 of 532, 13%) resulting from poor performance/pt's refusal/comorbidity (31/23/18), the former had younger age (p = 0.046), better performance (p < 0.001), and less advanced metastatic sites (p = 0.001) than the latter. Median overall survivals from diagnosis of unresectable cancer were 12.0/13.3/2.5 months for overall/CTx/BSC, respectively. 87%/47%/23% of the whole pts received 1st/2nd/3rd-line CTx, respectively. Median number of regimens delivered was 2. Maximally 5th-line CTx was given to 15 pts (3%). Response and disease control rates were 21.7%/12.5%/11.8% and 79.4%/56.3%/49.4% for 1st/2nd/3rd lines, respectively. Median progression-free and overall survivals from CTx were 5.5/3.4/2.5 months and 12.1/7.9/5.5 months for 1st/2nd/3rd lines, respectively. The most common cause of discontinuation of CTx was disease progression (68%/74%/70%) followed by pt's refusal (22%/13%/12%) for 1st/2nd/3rd lines, respectively. Prognosticators were performance status, histology, metastatic site, and CTx before 1st or 2nd line. Conclusions: When pts with unresectable gastric cancer were managed with a strategy of maximal administration of CTx, a considerable number of pts could receive 2nd or 3rd line CTx, showing modest activity. Performance status and metastatic site were consistent prognosticators even if lines changed. Our data on the natural history of stage IV gastric cancer with sequential CTx may suggest that clinical trials can be performed in a 2nd or 3rd line setting as well. No significant financial relationships to disclose.

scholarly journals Survival benefits of palliative gastrectomy in stage IV gastric cancer: a propensity score matched analysis

2020 ◽  
Vol 11 (2) ◽  
pp. 376-385 ◽  
Author(s):  
Wanren Peng ◽  
Tai Ma ◽  
Hui Xu ◽  
Zhijun Wu ◽  
Changhao Wu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy

Palliative gastrectomy and chemotherapy for stage IV gastric cancer

2007 ◽  
Vol 134 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Sheng-Zhang Lin ◽  
Hong-Fei Tong ◽  
Tao You ◽  
Yao-Jun Yu ◽  
Wei-Jun Wu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy

Palliative resection for stage IV gastric cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 148-148 ◽  
Author(s):  
O. Muto ◽  
H. Kotanagi
Keyword(s):  
Gastric Cancer ◽  
Survival Time ◽  
Surgical Resection ◽  
Median Survival ◽  
Median Survival Time ◽  
Stage Iv ◽  
Tissue Type ◽  
Term Survival ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy

148 Background: Metastatic gastric adenocarcinoma is an incurable condition and little progress has been made in its treatment. The role of palliative surgical resection is still debatable. Methods: We retrospectively evaluated the efficacy of palliative gastrectomy for treating incurable gastric cancer. In our institution 51 cases were found to have incurable tumors at laparotomy and received palliative gastrectomy from 2003 through 2009. In the analysis, particular attention was paid to the prognostic factors of age, tissue type (diffuse type and intestinal type), metastatic site (liver, peritoneal and lymph node) and postoperative chemotherapy. Results: One-year survival rate of all patients was 58% and the median survival time was 23.5 months. The median survival time was significantly greater in patients undergoing chemotherapy group than in those not undergoing chemotherapy (24.0 versus 9.4 months; p=0.016). Conclusions: Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection and chemotherapy is achievable. Further study with a larger number of patients is warranted. No significant financial relationships to disclose.

Changing national trends and survival in stage IV gastric cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 81-81 ◽  
Author(s):  
Anna M. Leung ◽  
Connie G. Chiu ◽  
Danielle M. Hari ◽  
Myung-Shin Sim ◽  
Anton J. Bilchik
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Negative Impact ◽  
Survival Rates ◽  
Stage Iv ◽  
Rank Test ◽  
Treatment Pathways ◽  
Stage Iv Gastric Cancer ◽  
Cancer Data ◽  
Palliative Gastrectomy

81 Background: With more effective systemic chemotherapy, the role for palliative gastrectomy in patients with Stage IV gastric cancer has been questioned. Methods: Using the National Cancer Data Base we identified 29,655 patients with Stage IV gastric cancer over a 14 year period (1994-2008). Patient demographics, tumor related features, and treatments were analyzed. Overall survival rates were examined using log-rank test power analysis. Results: There was a decrease in surgical resection from 31.2% in 2000 to 22% in 2008 (p<0.0001), a decrease in radiation from 20% in 2000 to 18.5% in 2008 (p= 0.0009), and an increase in systemic therapy from 45.5% in 2000 to 55.1% in 2008 (p<0.001). There were no differences in gender, age, or histology, but there was a decreasing trend of Caucasians diagnosed (p<0.0001). Survival rates decreased significantly over time p<0.05 (see table below). Conclusions: Over the past 14 years there has been an increase in the use of systemic chemotherapy and a reduction in palliative gastrectomy for stage IV gastric cancer. The negative impact on survival suggests that treatment pathways be re-evaluated. [Table: see text]

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