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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2019; 11(9): 652-664
Published online Sep 15, 2019. doi: 10.4251/wjgo.v11.i9.652
Advancements and challenges in treating advanced gastric cancer in the West
Jennifer L Leiting, Travis E Grotz
Jennifer L Leiting, Travis E Grotz, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Leiting JL and Grotz TE conceived and drafted the manuscript; both authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
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/
Corresponding author: Travis E Grotz, MD, Assistant Professor, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN 55905, United States. grotz.travis@mayo.edu
Telephone: +1-507-2841529Fax: +1-507-2845196
Received: February 6, 2019
Peer-review started: February 12, 2019
First decision: June 4, 2019
Revised: July 2, 2019
Accepted: July 29, 2019
Article in press: July 29, 2019
Published online: September 15, 2019
Processing time: 218 Days and 6.8 Hours
Abstract

Gastric cancer is a leading cause of cancer incidence and death worldwide. Patients with advanced gastric cancer benefit from a multi-modality treatment regimen. Sound oncologic resection with negative margins and complete lymphadenectomy plays a crucial role in long-term survival for patients with resectable disease. The utilization of minimally invasive techniques for gastric cancer has been slowly increasing and is proving to be both technically and oncologically safe. Perioperative chemotherapy is the current standard of care for advanced gastric cancer. A variety of chemotherapy regimens have been used with the combination of docetaxel, oxaliplatin, 5-fluorouracil, and leucovorin being the current recommendation given its superior ability to induce a complete pathologic response and prolong survival. The use of radiation has been more controversial with its optimal place in the treatment sequence being unclear. There are current ongoing studies assessing the impact of radiation as an adjunct or in place of chemotherapy. Targeted treatments (e.g., trastuzumab for human epidermal growth factor receptor 2 positive tumors and pembrolizumab for programmed death-ligand 1 positive tumors) are showing promise and are part of a continued emphasis on individualized care. Intraperitoneal chemotherapy may also play a role in preventing peritoneal recurrences for patients with high risk lesions. The treatment of patients with advanced gastric cancer in the West continues to advance and improve with a better understanding of optimal treatment sequences and the utilization of personalized treatment regimens.

Keywords: Gastric cancer; D2 lymphadenectomy; Minimally invasive surgery; Neoadjuvant chemotherapy; Chemoradiation; Targeted treatments

Core tip: The treatment of advanced gastric cancer in the West continues to evolve and advance. Surgery-related outcomes continue to improve and have included the addition of minimally invasive surgery techniques. The use of chemotherapy to improve long-term survival outcomes has been demonstrated in randomized-controlled trials, though the best regimen to use continues to be investigated. Chemoradiation has also been shown to improve outcomes, though the timing, sequence, and patient-population for optimal benefit has yet to be determined. Targeted-therapies and intraperitoneal chemotherapy may also play a role in the treatment of patients with advanced gastric cancer.