You are here
Articles on Chemotherapy & Chemoradiotherapy in Gastric Cancer
This section of the Advances in Gastrointestinal Cancer Resource Centre focuses on the latest clinically relevant findings in chemotherapy and chemoradiotherapy for gastrointestinal cancers. The peer-reviewed articles available here have been independently selected, and several commented upon, by members of the Editorial Board. Many of the articles are freely available for downloading.
Focusing initially on gastric cancer, these pages will provide new content each month to help you stay abreast of recent scientific developments in this area.
The use of chemotherapy or chemoradiotherapy (or both) is currently recommended for the treatment of gastric cancer in guidelines from both the USA (NCCN) and Europe (ESMO-ESSO-ESTRO).1 Depending on tumour stage and resectability, patients may be given chemotherapy or chemoradiotherapy preoperatively, postoperatively, or as an adjuvant therapy. Recommended second-line chemotherapy options include irinotecan and docetaxel or paclitaxel. Palliative therapy for inoperable or metastatic gastric cancer may include fluoropyrimidine- or taxane-based chemoradiotherapy or chemotherapy.
Other chemotherapeutic options depend on the patient's HER-2 status. Combination regimens based on a platinum–fluoropyrimidine doublet are generally used for HER-2 negative disease, possibly also with an anthracycline (e.g. epirubicin). Trastuzumab plus cisplatin and either 5-fluorouracil or capecitabine are recommended for HER-2 positive disease.
Treatment options are continually expanding, through use of new combinations of existing or novel therapies, new drugs or treatment approaches, and different ways of administering therapy.
To stay abreast of the most recent developments and clinical trial findings in the use of chemotherapy and chemoradiotherapy for the treatment of gastrointestinal cancers, please subscribe to our eAlert to ensure you are informed of all new content as it is published on this platform.
ESMO-ESSO-ESTRO: European Society for Medical Oncology, European Society of Surgical Oncology, and European Society for Therapeutic Radiology and Oncology; HER-2, human epidermal growth factor receptor 2; NCCN: (US) National Comprehensive Cancer Network.
1. Cabebe EC. Gastric cancer treatment & management. Approach considerations. In Medscape: Drugs & Diseases. Available from: http://emedicine.medscape.com/article/278744-treatment. Last updated 11 Nov 2015; accessed 7 Apr 2016.
Loss of human epidermal growth factor receptor 2 (HER2) expression in HER2-overexpressing esophagogastric (EG) tumors treated with trastuzumab
Janjigian YY, Riches JC, Ku GY, Imtiaz T, Capanu M, Chou JF, et al.Journal of Clinical Oncology 2015;33(3 suppl):63
Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer The AIO-FLOT3 Trial
Al-Batran SE, Homann N, Pauligk C, Illerhaus G, Martens UM, Stoehlmacher J, et al.
Commentary by Prof Lordick and Dr Elizabeth Smyth:
FLOT-3 shows there is an intermediate prognostic group of gastric cancer consisting of patients who present with limited metastatic spread to distant lymph nodes or oligotopic distant organ metastases. Patients with these intermediate clinical stages have a worse prognosis than patients with only locoregional disease but they have a better prognosis than patients with multifocal distant spread. Patients with limited metastatic burden could benefit from multimodality treatment including surgery. What this observation means for clinical decision making in routine practice should be clarified in prospective controlled trials.JAMA Oncol. 2017 Apr 27. doi: 10.1001/jamaoncol.2017.0515. [Epub ahead of print]
Trastuzumab emtansine versus taxane use for previously treated HER2-positive locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma (GATSBY): an international randomised, open-label, adaptive, phase 2/3 study
Thuss-Patience PC, Shah MA, Ohtsu A, Van Cutsem E, Ajani JA, Castro H, et al.
Commentary by Prof Lordick and Dr Elizabeth Smyth:
Trastuzumab plus chemotherapy is the standard of care for first-line treatment of HER2-positive advanced gastric cancer. Until today, there is no established anti-HER2 therapy in the second-line setting. The Gatsby study (trastuzumab emtansine [TDM-1] versus taxane use for previously treated HER2-positive locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma) investigated whether the anti-HER2 antibody-drug conjugate TDM-1 at a dose of 2.4mg/m2 weekly leads to better overall survival compared with taxane alone, (Thuss-Patience et al.)Lancet Oncol. 2017 May;18(5):640-653.
Mismatch Repair Deficiency, Microsatellite Instability, and Survival: An Exploratory Analysis of the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) Trial
Smyth EC, Wotherspoon A, Peckitt C, Gonzalez D, Hulkki-Wilson S Eltahir Z, et al.JAMA Oncol. 2017 Feb 23. [Epub ahead of print]
Ramucirumab combined with FOLFOX as front-line therapy for advanced esophageal, gastroesophageal junction, or gastric adenocarcinoma: a randomized, double-blind, multicenter Phase II trial
Yoon HH, Bendell JC, Braiteh FS, Firdaus I, Philip PA, Cohn AL, et al.Ann Oncol 2016;27:2196-2203.
Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma(FLOT4-AIO)
Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB, et al.Lancet Oncol. 2016 Dec;17(12):1697-1708.
A Randomized Phase II Study of FOLFOX With or Without the MET Inhibitor Onartuzumab in Advanced Adenocarcinoma of the Stomach and Gastroesophageal Junction
Shah MA, Cho JY, Tan IB, Tebbutt NC, Yen CJ, Kang A, et al.Oncologist. 2016 Jul 8. [Epub ahead of print]
Clinical role of ramucirumab alone or in combination with paclitaxel for gastric and gastro-esophageal junction adenocarcinoma
Davidson M, Smyth EC, Cunningham D.Onco Targets Ther 2016;9:4539–48.
Phase II study of the effectiveness and safety of trastuzumab and paclitaxel for taxane- and trastuzumab-naïve patients with HER2-positive, previously treated, advanced or recurrent gastric cancer (JFMC45-1102)
Nishikawa K, Takahashi T, Takaishi H, Miki A, Noshiro H, Yoshikawa T, et al.Int J Cancer 2016 Aug 13. [Epub ahead of print]
A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction
Klevebro F, Alexandersson von Döbeln G, Wang N, Johnsen G, Jacobsen AB, Friesland S, et al.Ann Oncol 2016 Apr;27(4):660-7