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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2016; 22(3): 1160-1171
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1160
Personalized medicine in gastric cancer: Where are we and where are we going?
Alexandre A Jácome, Anelisa K Coutinho, Enaldo M Lima, Aline C Andrade, José Sebastião dos Santos
Alexandre A Jácome, Enaldo M Lima, Aline C Andrade, Department of Medical Oncology, Hospital Mater Dei, Belo Horizonte 30190-131, Minas Gerais, Brazil
Anelisa K Coutinho, Department of Gastrointestinal Oncology, Brazilian Gastrointestinal Tumor Group, Clinica AMO, Salvador 41950-640, Bahia, Brazil
José Sebastião dos Santos, Department of Surgery and Anatomy, University of São Paulo at Ribeirão Preto, School of Medicine, Ribeirão Preto14049-900, São Paulo, Brazil
Author contributions: Jácome AA, Coutinho AK, Lima EM, Andrade AC and dos Santos JS contributed equally to this work; Jácome AA, Coutinho AK, Lima EM, Andrade AC and dos Santos JS performed the review of the literature, wrote and reviewed the paper.
Supported by Fundação Waldemar Barnsley Pessoa, Brazil.
Conflict-of-interest statement: The authors have no conflicts of interests to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alexandre A Jácome, MD, PhD, Department of Medical Oncology, Hospital Mater Dei, Av. Barbacena 1057, Belo Horizonte 30190-131, Minas Gerais, Brazil. jacome@usp.br
Telephone: +55-31-33399022 Fax: +55-31-33399022
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: August 25, 2015
Revised: September 22, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: January 21, 2016
Abstract

Despite improvements in adjuvant therapies for gastric cancer in recent years, the disease is characterized by high recurrence rates and a dismal prognosis. The major improvement in the treatment of recurrent or metastatic gastric cancer in recent years has been the incorporation of trastuzumab, a monoclonal antibody that inhibits human epidermal growth factor receptor 2 (HER2) heterodimerization, after the demonstrated predictive value of the overexpression and/or amplification of this receptor. Beyond HER2, other genetic abnormalities have been identified, and these mutations may be targetable by tyrosine kinase inhibitors or monoclonal antibodies. The demonstration of four distinct molecular subtypes of gastric cancer by the Cancer Genome Atlas study highlight the enormous heterogeneity of the disease and its complex interplay between genetic and epigenetic alterations and provide a roadmap to implement genome-guided personalized therapy in gastric cancer. In the present review, we aim to discuss, from a clinical point of view, the genomic landscape of gastric cancer described in recent studies, the therapeutic insights derived from these findings, and the clinical trials that have been conducted and those in progress that take into account tailored therapies for gastric cancer.

Keywords: Stomach neoplasms, Biological markers, Molecular targeted therapy, Individualized medicine, Transcriptome

Core tip: Gastric cancer is a highly heterogeneous disease. Recently, significant improvements have been made in the description of the genomic landscape of the disease, and these improvements provide a roadmap to implement genome-guided personalized therapy for gastric cancer. The present review aims to discuss the therapeutic insights derived from these recent findings and present the clinical trials that have been conducted and those in progress that take into account tailored therapies for gastric cancer from a clinical point of view.