Abstract
Tumors of the upper gastrointestinal tract are increasing in incidence; yet, approaches to the treatment of advanced gastric and/or gastroesophageal junction cancer vary widely, with no internationally agreed first‐line regimens. Recent clinical trials have shown that second‐line treatment is now possible for selected patients with advanced disease, and current data suggest that the combination of ramucirumab plus paclitaxel may become a standard of care in the second‐line setting for metastatic gastric cancer. Several prognostic factors have been identified for overall survival in the second‐line setting; this emphasizes the need for careful sequencing of all treatments to ensure that individual patients receive optimum care. This article reviews published data on the treatment of advanced gastric cancer, with a particular emphasis on second‐line chemotherapy, and suggests treatment sequences based on current understanding.
Highlights
Gastric cancer is the fifth most common cancer in the world, with an estimated 951,000 new cases diagnosed in 2012 (6.8% of total cancer cases) [1], and the third leading cause of cancer death in both sexes worldwide, with 723,000 deaths (8.8% of total cancer deaths) estimated in that year
For human epidermal receptor type 2 (HER2)-negative patients, a platinum/fluoropyrimidine-based doublet or triplet regimen is recommended; for HER2-positive patients, trastuzumab plus combining 5-FU/cisplatin (CF)/CX is recommended [31]
A platinum–fluoropyrimidine doublet therapy followed by second-line paclitaxel–ramucirumab or by second-line monotherapy with ramucirumab, irinotecan, or a taxane could be the best sequence of treatment for patients with advanced gastric cancer
Summary
Gastric cancer is the fifth most common cancer in the world, with an estimated 951,000 new cases diagnosed in 2012 (6.8% of total cancer cases) [1], and the third leading cause of cancer death in both sexes worldwide, with 723,000 deaths (8.8% of total cancer deaths) estimated in that year. A meta- analysis of data from these three studies showed a statistically significant improvement in OS with second-line chemotherapy in advanced gastric cancer (P < 0.0001) [12] In another trial comparing paclitaxel with irinotecan in Japanese patients, both drugs had similar positive effects on survival [43], with a median OS of 9.5 versus 8.4 months, respectively (P = 0.38). Neither study found differences in OS between sequences Based on these considerations, a platinum–fluoropyrimidine doublet (or a triplet with epirubicin) therapy followed by second-line paclitaxel–ramucirumab (in patients with a good ECOG PS) or by second-line monotherapy with ramucirumab, irinotecan, or a taxane (in patients with intermediate PS) could be the best sequence of treatment for patients with advanced gastric cancer. If response is not evaluated in a timely manner, disease progression during first line may go unnoticed, and the patient may suffer deterioration precluding the use of any further treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
