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World J Gastroenterol. Oct 14, 2014; 20(38): 13637-13647
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13637
Medical management of gastric cancer: A 2014 update
Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Jeannelyn S Estrella, Mariela A Blum, Brian Badgwell, Prajnan Das, Shumei Song, Jaffer A Ajani
Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States
Jeannelyn S Estrella, Pathology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States
Brian Badgwell, Surgical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States
Prajnan Das, Radiation Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Elimova E and Ajani JA both contributed to writing the original paper; Shiozaki H, Wadhwa R, Sudo K, Chen Q, Estrella JS, Blum MA, Badgwell B, Das P and Song S contributed by editing the text and adding information pertaining to their field of expertise.
Correspondence to: Jaffer A Ajani, MD, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, United States. jajani@mdanderson.org
Telephone: +1-713-7922330 Fax: +1-713-7944535
Received: December 12, 2013
Revised: February 15, 2014
Accepted: May 19, 2014
Published online: October 14, 2014
Processing time: 298 Days and 13 Hours
Abstract

Gastric cancer represents a serious health problem on a global scale. It is the second leading cause of cancer-related death worldwide. Novel therapeutic targets are desperately needed because the meager improvement in the cure rate of about 10% realized by adjunctive treatments to surgery is unacceptable as > 50% patients with localized gastric cancer succumb to their disease. Either postoperative chemoradiotherapy (United States), pre-and post-operative chemotherapy (Europe), and adjuvant chemotherapy after a D2 resection (Asia) can all be regarded as standards of care in the localized gastric cancer management. In metastatic disease the addition of trastuzumab to chemotherapy is standard of care in Her2 positive disease. In the HER2 negative population, the treatments remain limited. In the first line setting, the standard of care is a combination of fluoropyrimidine and platinum containing chemotherapy, with or without epirubicin or docetaxel. The results of targeted therapy trials have by and large been disappointing, but none of these trials looked at an appropriately enriched population. Finally there is a meager overall survival benefit in treating patients with metastatic disease in the second line setting, with either irinotecan, docetaxel or ramucirumab however none of these drugs have been compared head to head in a well-powered randomized controlled trial.

Keywords: Chemotherapy; Gastric cancer; Chemoradiation; Metastatic; Localized

Core tip: The standard of care for the management of localized gastric cancer continues to vary depending on where in the world this treatment takes place. In metastatic gastric cancer the outcomes remain poor. The first line treatment consists of trastuzumab in addition to chemotherapy in Her2 positive disease or fluoropyrimidine and platinum (with or without docetaxel or epirubicin) in Her2 negative disease. What is now clear is that second line chemotherapy, with either irinotecan, docetaxel or ramucirumab does improve overall survival.