Second-line treatment of metastatic gastric cancer: Current options and future directions

doi:10.3748/wjg.v21.i41.11621

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 21, Issue 41

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (10212)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Tables (1-3) series.

Item

Count

PDF

672

WORD

379

HTML

6163

Tables (1-3)

362

Sum=7576

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

1110

Download

1526

Sum=2636

Nov 7, 2015 (publication date) through Jan 22, 2025

Times Cited of This Article

Times Cited (31)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Topic Highlight

World J Gastroenterol. Nov 7, 2015; 21(41): 11621-11635
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11621

Table 1 Phase II studies on second-line therapy (Monotherapy) in metastatic gastric cancer

II line agent	Total/eval pts	Performance status, n	Doses(mg/m²)	TreatmentORR	MedianTTP (mo)	MedianPFS(mo)	MedianOS (mo)	Toxicity,grade3-4 (%)	Ref.
Irinotecan	37/35	ECOG 0/1 - 3/34	Iri - 125 d1 weekly × 4 wk, q42	20.0%	2.6	NR	5.2	A/L/N/T/N-E/D/FN/I - 56.8/45.9/67.6/8.1/ 18.9/18.9/16.2/8.1	Chun et al[19], 2004
Irinotecan	39/30	ECOG 0/1/2 - 18/10/2	Iri - 100 d1,d8,d15 q28	15.3%	2.9	NR	8.8	A/N/Leu/Ano/D/F/- 13/30/17/23/17/13	Mochizuki et al[20], 2013
Paclitaxel	36/36	ECOG 0/1/2 - 7/20/9	Ptx - 225 d1 q21	22.2%	5.0	NR	8.0	L/T - 17/17	Cascinu et al[21], 1998
Paclitaxel	38/25	ECOG 0/1/2 - 12/15/11	Ptx - 80 d1, 8, 15 q28	24.0%	2.1	NR	5.0	L/N/T/Nau/Ano/D/ Neu - 29/32/8/3/3/3/6	Hironaka et al[22], 2006
Paclitaxel	45/44	ECOG 0/1/2 - 26/13/6	Ptx - 80 d1, 8, 15 q28	16.0%	NR	2.6	7.8	A/N/L/D/N-E/As/Neu - 11/16/18/2/4/11/2	Kodera et al[23], 2007
Docetaxel	30/29	KPS Median 70 (R 60-100%)	Dtx - 100 d1 q21	17.0%	NR	NR	6.0	A/L/N - 7/7/18	Giuliani et al[24], 2003
Docetaxel	154/86	ECOG 0-1/2 - 130/24	Dtx - 75 d1 q21	14.0%	2.6	NR	7.2	A/N/FN/As - 10.5/12.5/9.9/13.6	¹Jo et al[25], 2007
Docetaxel	49/49	ECOG 0/1/2 - 9/36/4	Dtx - 75 d1 q21	16.5%	2.5	NR	8.3	A/L/N/FN/B/As/D/Neu - 5.4/4.8/5.4/5.4/1.2/ 10.8/2.4/8.4	Lee et al[26], 2008
Nab-Paclitaxel	56/54	ECOG 0/1 - 33/23	Nab-Ptx 250 d1 q21	27.8%	NR	2.9	9.2	A/L/N/Ly/Neu - 7.3/20/49.1/10.9/23.6	Sasaki et al[27], 2014
Pemetrexed	34/30	ECOG 0/1/2 - 7/20/7	Pem - 500 d1 q 21	63.6%	NR	2.3	6.4	A/N/T/As - 2.9/2.9/2.9/5.8	Zhang et al[28], 2015
Sunitinib	78/69	ECOG 0/1 - 26/52	Sun - 50 mg/d × 4 wk, q42	2.6%	2.3	2.3	6.8	A/L/N/T/E/D/HFS/S - 16.7/11.5/29.4/34.6/ 3.8/2.6/6.4/1.3	Bang et al[29], 2010
Everolimus	54/53	ECOG 0/1 - 32/21	Ev - 10 mg/d d1-28	0%	NR	2.7	10.1	P (gr 1-2)/A/Ly/As/S/ Ano/HyG/HyP/HyN/ - 15.1, 9.4/7.5/5.7/ 5.7/ 5.7/3.8/3.8/9.6	Doi et al[30], 2010

¹Retrospective study. Dtx: Docetaxel; Ev: Everolimus; F: 5-fluorouracil; FA: Leucovorin; Iri: Irinotecan; MMC: MitomycinC; Nab-Ptx: Nab-paclitaxel; Pem: Pemetrexed; Ptx: Paclitaxel; Sun: Sunitinib; ECOG: Eastern co-operative oncology group; KPS: Karnoffsky performance status; NR: Not reported; ORR: Objective response rate; OS: Overall-survival; Pts: Patients; PFS: Progression-free survival; R: Range; TTP: Time-to-progression; A: Anemia; As: Asthenia; Ano: Anorexia; B: Bilirubin; D: Diarrhea; E: Emesis; FN: Febrile neutropenia; HFS: Hand-foot syndrome; HyG: Hyperglycemia; HyN: Hyponatremia; HyP: Hypophosphatemia; I: Infection; L: Leucocytopenia; Ly: Lymphopenia; M: Mucositis; N: Neutropenia; Neu: Sensory neuropathy; Nau: Nausea; N-E: Nausea and vomiting; T: Thrombocytopenia.

Table 2 Phase II studies on second-line therapy (combination therapy) in metastatic gastric cancer

Study	Total /eval pts	Performance Status, n	II-line treatment,doses (mg/m²)	TreatmentORR	Median TTP (mo)	MedianPFS(mo)	MedianOS(mo)	Toxicity,grade3-4 (%)	Ref.
Irinotecan/ FU	40/38	ECOG 0/1/2 - 5/21/12	Iri/FA/FU - 180/125/400 bolus + 1200 inf over 22 h d1/d1/d1 q14	29.0%	NR	3.7	6.4	A/N/FN/I/N-E/D/As - 13/26/5/16/13/8/16	Assersohn et al[31], 2004
Irinotecan/ FU	64/57	ECOG 0/1/2 - 3/58/3	Iri/FU/FA - 150/100/1000 d1/d1/d1, 2 over 24 h q14	21.0%	2.5	NR	7.6	N/T/D/E - 11/8/3/3	Kim et al[32], 2005
Irinotecan/ FU	51/48	ECOG 0-1/2 - 35/16	Iri/FA/FU - 180/200/400 bolus + 600 inf over 22 h d1/d1/d1 q14	18.0%	NR	3.2	9.1	A/N/FN/D/Nau/E - 14/17/1/6/6/4	¹Seo et al[33], 2008
Irinotecan/ Cisplatin	32/31	ECOG 0/1/2 - 1/22/9	Iri/P - 70/30 d1, 15/d1, 15 q28	15.6%	3.7	NR	6.1	A/N/T/E/D/M/Ano - 2.6/6/4.3/1.7/1.7/3.4/5.2	Baek et al[34], 2005
Irinotecan/ Cisplatin	87/70	ECOG 0/1/2 - 29/53/5	Iri/P - 70/80 d1, 15/d1 q28	28.6%	4.3	NR	9.5	A/L/N/FN/T/D/As/Nau - 28/34/40/10/8/6/5/2	¹Takahari et al[35], 2010
Irinotecan/ Mitomycin C	38/38	KPS Median 80 (R 70-100%)	Iri/MMC - 150/8 d1, 15/d1 q28	32.0%	4.0	NR	8.0	A/L/N - 5/8/21	Giuliani et al[36], 2005
Irinotecan/ Mitomycin C	45	ECOG 0/1 - 24/21	Iri/MMC - 150/5 d1 q14	29.0%	NR	4.1	10.1	A/N/FN/D/I - 13/53/9/2/4	Hamaguchi et al[37], 2011
Irinotecan/ Capecitabine	48/46	ECOG 0/1/2 - 10/32/6	Iri/Cap - 100/1000 b.i.d d1, 8/d1-14 q21	27.1%	4.1	NR	7.6	N/FN/E/D/HFS - 8.7/4.3/4.3/17.4/4.3	Sun et al[38], 2009
Irinotecan/ Cetuximab	63/54	ECOG 0/1 - 28/35	Iri/Cet - 180/500 d1 q14	11.0%	NR	2.8	6.1	N/FN/D/F - 11/2/6/5	Schønnemann et al[39], 2012
Irinotecan vs	29 vs 30	ECOG 0/1 - 27/2 vs 27/3	Iri 150 d1 q14	17.2% vs 20.0%	NR	2.2 vs 3	5.8 vs 6.7	A/n/Leu/FN/Ano/As/D - 0/20/28/0/10/10/3 vs 10/13/37/3/13/3/7	Sym et al[40], 2013
Irinotecan/ mFOLFIRI	29 vs 30	ECOG 0/1 - 27/2 vs 27/3	Iri/mFOLFIRI 150 d1 + LV20 d1, 5-FU 2000 over 48 h	17.2% vs 20.0%	NR	2.2 vs 3	5.8 vs 6.7		Sym et al[40], 2013
Paclitaxel/ Doxifluridine	52/25	ECOG R 0-2	Dox/Ptx - 600 mg/70 d1-21/d7, 14, 21 q28	28.0%	NR	NR	5.8	L - 2	Arai et al[41], 2007
Paclitaxel/ Doxifluridine	33	ECOG 0/1/2 - 21/14/0	Dox/Ptx - 600 mg/70 d1-14/d1, 8 q21	18.2%	NR	4.0	10.7	A/L/N/D/FN/I/As/Neu - 17.1/11.4/22.9/2.9/ 2.9/2.9/2.9	Takiuchi et al[42], 2008
Paclitaxel/ Carboplatin	50/47	ECOG 0-1/2 - 25/22	Ptx/Carbo - 175/AUC 5 d1/d1 q21	27.7%	NR	NR	OS in PR/SD - 10.0/6.0	N/T - 8.5/4.2	Stathopoulos et al[43], 2002
Paclitaxel/ Cisplatin	32/30	ECOG 0-1/2 - 21/11	Ptx/P - 145/60 d1 q21	25.0%	2.9	NR	9.1	N/E/Neu - 3/9/6	Lee et al[44], 2007
Paclitaxel/ Capecitabine	26/26	ECOG 0/1/2 - 7/11/8	Ptx/Cap - 175/825 b.i.d d1/d1-14 q21	34.6%	4.5	NR	7.5	A/N/T/HFS/Neu/Ar/E - 3.8/11.5/3.8/11.5/ 11.5/7.5/3.8	Baize et al[45], 2009
Paclitaxel/ Capecitabine	36/35	KPS Median 80 (R 60-100%)	Ptx/Cap - 80/1000 b.i.d d1, d8/d1-14 q21	28.5%	NR	5.0	11.1	N/N-E/HFS - 11.1/5.6/5.6	Zhang et al[46], 2013
Paclitaxel/ S-1	30	ECOG 0-1/2 -23/7	Ptx/S-1 - 120 d1 q14 /80, 100, 120 mg/d, if BSA < 1.25 m², 1.26 m²-1.49 m², ≥ 1.50 m² b.i.d. d1-7 q14	33.3%	NR	3.6	7.2	A/Neu/T/Ano/Neu/D/F - 73.4/63.4/16.6/20/36.6/13.3/20	Zheng et al[47], 2014
Docetaxel/ Cisplatin	43/41	ECOG 0/1/2 - 1/33/9	Dtx/P - 60/60 d1/d1 q21	17.1%	NR	2.2	5.8	N/N-E/Neu/Neph - 29.3/12.2/4.9/2.3	Park et al[48], 2004
Docetaxel/ Cisplatin	30/30	KPS 50-70/ 80-100% - 14/16	Dtx/P - 60/60 d1/d1 q21	26.7%	4.5	NR	5.6	A/L/N/Nau - 3/27/27/3	Kunisaki et al[49], 2005
Docetaxel/ Cisplatin	32/32	ECOG 0/1/2 - 8/16/8	Dtx/P 70/70 d1/d1 q21	16.0%	5.0	NR	6.0	N/FN/T/D - 59/12/12/6	Polyzos et al[50], 2006
Docetaxel/ Oxaliplatin	38/37	ECOG 0/1/2 - 19/12/7	Dtx/Ox - 75/80 d1/d2 q21	10.5%	4.0	NR	8.1	N/As/Nau/Neu - 26.3/15.7/15.7/3	Barone et al[51], 2007
Docetaxel/ Oxaliplatin	48/46	ECOG 0/1/2 - 11/29/8	Dtx/Ox - 60/130 d1 q21	22.9%	4.4	NR	7.2	L/N/FN/T/N-E/D/Neu - 17.4/26/7/4.3/28.3/ 15/6.5	Zhong et al[52], 2008
Docetaxel/ Epirubicin	50/45	ECOG 0/1/2 - 12/16/22	Dtx/Epi - 75/60 d1/d1 q21	15.5%	2.4	NR	5.0	N/FN/T/N-E/S/D/Neu - 68/48/46/2/8/4/2	Nguyen et al[53], 2006
Docetaxel/ Capecitabine	28/25	ECOG 0/1/2 - 2/19/7	Dtx/Cap - 60/1000 b.i.d d1/d1-14 q21	29.0%	4.0	NR	6.0	A/N/As/D/HFS - 7/36/7/11/7	Rosati et al[54], 2007
Docetaxel/ Etoposide	32/32	ECOG 0/1/2 - 6/20/6	Dtx/Eto - 75/50 d1/d1-5 q21	9.4%	NR	3.0	6.0	N/FN/T/N-E/D/M - 29/19/3/15.6/9.4/6.2	Yildiz et al[55], 2010
Docetaxel/ Cetuximab	38/35	ECOG 0/1/2 - 15/21/2	Dtx/Cet - 30 d1, d15 q21/400 d1, then 250 d1 q7	6.0%	NR	2.1	5.4	I/FN/Ano/D/F - 11/3/16/11/29	Tebbutt et al[56], 2013
Mitomycin/ S1	43/33	ECOG 0/1/2 - 13/21/9	MMC/S-1 - 7/40 b.i.d d1/d1-28 q42	21.0%	NR	3.4	8.0	A/N/T/D/N-E/As/S - 7/5/5/10/7/12/10	Park et al[57], 2008
Mitomycin/ Capecitabine	39	ECOG 0/1/2/UNK - 6/25/5/3	MMC/Cap - 10/1000 bid d1/d1-d14 q21	10.3%	NR	2.8	5.6	Leu/T/D/F/HFS/Neu - 5.4/10.8/5.4/8.1/5.4/8.1	Miranda et al[58], 2014
Methotrexate/ FU	56/55	ECOG 0/1/2/3 - 12/30/12/2	Mtx/FU/FA - 100 bolus/600 bolus (3 h after MTX)/10, every 6 h for 6 doses (24 h after MTX) q7	9.0%	NR	NR	7.8	A/L/N/T/N-E/D/S - 9.1/5.5/6.7/1.8/3.6/ 3.6/1.8	Hamaguchi et al[59], 2008
Cisplatin/ FU	58/53	ECOG 0-1/2 - 20/33	P/FU - 20/1000 over 20 h inf d1-5/d1-5 q28	11.3%	1.8	NR	4.6	A/N/T/N-E/D/M/Neu - 8/9/9/11/4/6/1	Sencan et al[60], 2008
Oxaliplatin/ Sorafenib	40	ECOG 0/1/2 - 14/23/2	Ox/Sor - 130 d1 q21/400 mg b.i.d daily	2.8%	NR	3.0	6.5	N/T/As/D/Neu - 9.8/7.3/18/4.9/4.9	Martin-Richard et al[61], 2013

¹Retrospective study. Cap: Capeceitabine; Carbo: Carboplatin; Cet: Cetuximab; Dox: Doxifluridine; Dtx: Docetaxel; Eto: Etoposide; Epi: Epirubicin; FU: 5-fluorouracil; FA: Leucovorin; Iri: Irinotecan; Mtx: Methotrexate; MMC: MitomycinC; Ox: Oxaliplatin; P: Cisplatin; Ptx: Paclitaxel; Sor: Sorafenib; ECOG: Eastern co-operative oncology group; KPS: Karnoffsky performance status; NR: Not reported; ORR: Objective response rate; OS: Overall-survival; Pts: Patients; PR: Partial response; PFS: Progression-free survival; R: Range; SD: Stable disease; TTP: Time-to-progression; UNK: Unknown; A: Anemia; As: Asthenia; Ano: Anorexia; D: Diarrhea; E: Emesis; FN: Febrile neutropenia; HFS: Hand-foot syndrome; I: Infection; L: Leucocytopenia; M: Mucositis; N: Neutropenia; Neu: Sensory neuropathy; Nau: Nausea; N-E: Nausea and vomiting; S: Stomatitis; T: Thrombocytopenia.

Table 3 Phase III studies on second-line therapy in metastatic gastric cancer

Ref.	II-line treatment (mg/m²)	Total pts	Performance Status, (ECOG/WHO) (%)	Median ORR (%)	MedianPFS(mo)	MedianOS(mo)	Hazard ratio	Toxicity,grade3-4 (%)
Thuss-Patience et al[62], 2011	Iri 250 cycle 1; 350 subsequent cycles	21/19	0-1/2 - 81/19	0	2.5	4.0	0.48, P = 0.012	D/FN/L/A - 26/16/21/11
Thuss-Patience et al[62], 2011	BSC	19	0-1/2 - 74/26	NR	NR	2.4	0.48, P = 0.012	NR
Kang et al[63], 2012	Dtx 60 d1 q3w;	133	0/1 - 54/46	13.0	NR	5.3	0.657, P = 0.007	Doc: N/A/F/Ano/D/S - 15/30/26/6/3/3
	Iri 150 d1 q2w	133	0/1 - 54/46	13.0	NR	5.3		Iri: N/A/F/Ano/D/S - 18/32/10/5/8/5
	BSC	69	0/1 - 52/48	NR	NR	3.8		N/A/F/D/S - 2/23/27/10/5/2
Hironaka et al[64], 2013	Iri 150 d1/d15 q4w	112	0-1/2 - 96.4/3.6	13.6¹	2.3¹	8.4	1.13, P = 0.38	L/N/A/FN/Ano/Neu/D/AST/Na - 19.1/39.1/30/9.1/17.3/0/4.5/8.2/15.5
Hironaka et al[64], 2013	Ptx 80 d1/d8/d15 q4w	111	0-1/2 - 96.3/3.7	20.9¹	3.6¹	9.5	1.13, P = 0.38	L/N/A/FN/Ano/Neu/D/AST/Na - 20.4/28.7/21.3/2.8/7.4/7.4/0.9/3.7/3.7
Ford et al[65], 2014	Doc 75 d1 q3w	84	0/1/2 - 28/55/17	7.0	29% (at 24 wk)	5.2	0.67, P = 0.01	N/A/FN/I/H/P/Neu - 15/6/7/15/1/11/4
Ford et al[65], 2014	BSC	84	0/1/2 - 28/60/14	NR	NR	3.6	0.67, P = 0.01	N/A/FN/I/H/P/Neu - 0/5/0/3/6/20/4
Higuchi et al[66], 2014	Iri 60 d1 q2w;	64	0/1 - 69/31	22.0¹	3.8	10.7¹	1.00, P = 0.982	N/A/FN/T/D/Ano/F - 13/16/0/0/2/6/3
	Cis 30 d1 q2w	64	0/1 - 69/31	22.0¹	3.8	10.7¹		N/A/FN/T/D/Ano/F - 13/16/0/0/2/6/3
	Iri 150 d1 q4w	66	0/1 - 68/32	16.0¹	2.8	10.1¹		N/A/FN/T/D/Ano/F - 36/18/5/2/6/11/6
Nishikawa et al[67], 2015	Iri 60 d1 q2w;	84	0/1 - 81/19	16.9¹	4.6¹	13.9¹	0.834, P = 0.288	N/A/T/D/Ano/F - 35/16/1/0/6/9
	P 30 d1 q2w	84	0/1 - 81/19	16.9¹	4.6¹	13.9¹		N/A/T/D/Ano/F - 35/16/1/0/6/9
	Iri 150 d1 q4w	84	0/1 - 75/25	15.4¹	4.1¹	12.7¹		N/A/T/D/Ano/F - 28/4/0/3/9/4
Fuchs et al[69], 2014	Ram 8 mg/kg d1 q2w	238	0/1/2 - 28/72/0	3.4¹	2.1	5.2	0.776, P = 0.047	A/F/AbP/Dys/Dyn/Hyt/B/Prot/VTE - 6/6/6/2/2/8/3/< 1/1
	BSC	238	0/1/2 - 28/72/0	3.4¹	2.1	5.2		A/F/AbP/Dys/Dyn/Hyt/B/Prot/VTE - 6/6/6/2/2/8/3/< 1/1
	Placebo	117	0/1/2 - 26/73/0	3.0¹	1.3	3.8		A/F/AbP/Dys/Dyn/Hyt/B/Prot/VTE - 8/10/3/4/6/3/3//< 1
	BSC	117	0/1/2 - 26/73/0	3.0¹	1.3	3.8		A/F/AbP/Dys/Dyn/Hyt/B/Prot/VTE - 8/10/3/4/6/3/3//< 1
Wilke et al[70], 2014	Ram 8 mg/kg d1,15 q4w	330	0/1 - 35/65	27	4.4	9.6	0.807, P = 0.017	N/A/Leu/T/F/Neu/D/H/Hyt/Prot/HepF/VTE - 41/9/18/2/8/4/4/15/1/4/2
	Ptx 80 d1/d8/d15 q4w	330	0/1 - 35/65	27	4.4	9.6	0.807, P = 0.017
	Placebo	335	0/1 - 43/57	16	2.9	7.4		N/A/Leu/T/F/Neu/D/H/Hyt/Prot/HepF/VTE - 19/9/6/2/5/5/1/4/3/0/3/2
	Ptx 80 d1/d8/d15 q4w	335	0/1 - 43/57	16	2.9	7.4
Satoh et al[76], 2014	Lap 1500 mg once daily	132	0/1 - 45/55	27	5.5¹	12.2¹	0.84, P = 0.2	(experienced in > 10% of pts) N/A/Lym/F/Neu/D - 57/11/29/5/< 1/18
	Ptx 80 d1,d8,d15 q4w	132	0/1 - 45/55	27	5.5¹	12.2¹
	Placebo	129	0/1 - 37/63	9	4.4¹	10.5¹		(experienced in > 10% of pts) N/A/Lym/F/Neu/D - 31/6/2/< 1/0/2
	Ptx 80 d1,d8,d15 q4w	129	0/1 - 37/63	9	4.4¹	10.5¹
Dutton et al[77], 2014	Gef 500 mg/d daily	224	0/1/2 - 25/52/22	24 (DC)	1.57	3.73¹	0.90, P = 0.293	D/F/Sk/Rep/I/Hem/Vas/Met - 6/10/20/12/3/7/7/6
Dutton et al[77], 2014	Placebo	225	0/1/2 - 25/55/20	16 (DC)	1.17	3.67¹	0.90, P = 0.293	D/F/Sk/Rep/I/Hem/Vas/Met - 1/5/< 1/12/4/4/5/7

¹The P value non-significant. BSC: Best Supportive Care; Dtx: Docetaxel; Gef: Gefitinib; Iri: Irinotecan; Lap: Lapatinib; P: Cisplatin; Ptx: Paclitaxel; Ram: Ramucirumab; DC: Disease control; ECOG: Eastern Co-operative Oncology Group; NR: Not reported; ORR: Objective Response Rate; OS: Overall-survival; PFS: Progression-free survival; Pts: Patients; WHO: World Health Organization; A: Anemia; AbP: Abdominal Pain; Ano: Anorexia; B: Bilirubin; D: Diarrhea; Dys: Dysphagia; Dyn: Dyspnea; E: Emesis; FN: Febrile neutropenia; H: Hemorrhage; Hem: Hematologic toxicity; HepF: Hepatic failure; Hyt: Hypertension; I: Infection; L: Leucocytopenia; Ly: Lymphopenia; M: Mucositis; Met: Toxicity associated with metabolism and nutrition; N: Neutropenia; Neu: Sensory neuropathy; Nau: Nausea; N-E: Nausea and vomiting; P: Pain; Prot: Proteinuria; Resp: Respiratory toxicity; Sk: Skin toxicity; T: Thrombocytopenia; Vas: Vascular toxicity; VTE: Venous thromboembolic events.

Citation: Kanagavel D, Fedyanin M, Tryakin A, Tjulandin S. Second-line treatment of metastatic gastric cancer: Current options and future directions. World J Gastroenterol 2015; 21(41): 11621-11635
URL: https://www.wjgnet.com/1007-9327/full/v21/i41/11621.htm
DOI: https://dx.doi.org/10.3748/wjg.v21.i41.11621