Abstract
Metastatic or recurrent gastric cancer is regarded as an incurable condition, and chemotherapy is usually used as standard palliation. Four major lines have been developed from chemotherapy to molecular targeted therapy for advanced gastric cancer (AGC) in Taiwan. First, the unique weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and leucovorin regimen (acronym, HDFL) has satisfactory single-agent activity, minimal myelosuppression, and mild toxicity. A variety of HDFL-based doublet combinations (such as cisplatin-HDFL, paclitaxel-HDFL, oxaliplatin-HDFL) have become the cornerstone regimens with high efficacy and manageable toxicity. Second, novel active drugs hold promise for improved palliation and survival extension in AGC. Among them, oxaliplatin, taxanes (docetaxel, paclitaxel), irinotecan, and oral fluoropyrimidines (S-1, capecitabine) appear to be very relevant candidates. Third, the first-line sequential non-cross-resistant chemotherapy strategy is useful to prolong overall survival in patients with AGC. Fourth, through the applications of molecular targeted therapy (such as cetuximab, everolimus, bevacizumab, etc.), and studies of pharmacogenomics in the post-genomic era, personalized drug therapy will further improve the efficacy and decrease the toxicity.
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