Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2015; 7(11): 263-270
Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.263
Novel therapy for advanced gastric cancer
Yue Zhang, Shenhong Wu
Yue Zhang, Shenhong Wu, Division of Hematology and Oncology, Stony Brook University, Stony Brook, NY 11794-8151, United States
Author contributions: Zhang Y and Wu S contributed the same to this paper.
Conflict-of-interest statement: None 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/
Correspondence to: Yue Zhang, MD, MPH, Assistant Professor, Division of Hematology and Oncology, Stony Brook University, HSC 15-040, 101 Nicholls Rd, Stony Brook, NY 11794-8151, United States. yue.zhang@stonybrookmedicine.edu
Telephone: +1-631-6381000 Fax: +1-631-6380915
Received: June 18, 2015
Peer-review started: June 20, 2015
First decision: July 27, 2015
Revised: August 14, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: November 15, 2015

Gastric cancer (GC) is a common lethal malignancy. Gastroesophageal junction and gastric cardia tumors are the fastest rising malignancies due to increasing prevalence of obesity and acid reflex in the United States. Traditional chemotherapy remains the main treatment with trastuzumab targeting human epidermal growth factor receptor 2 positive disease. The median overall survival (OS) is less than one year for advanced GC patients; thus, there is an urgent unmet need to develop novel therapy for GC. Although multiple targeted agents were studied, only the vascular endothelial growth factor receptor inhibitor ramucirumab was approved recently by the United States Food and Drug Administration because of its 1.4 mo OS benefit (5.2 mo vs 3.8 mo, P = 0.047) as a single agent; 2.2 mo improvement of survival (9.6 mo vs 7.4 mo, P = 0.017) when combined with paclitaxel in previously treated advanced GC patients. It is the first single agent approved for previously treated GC and the second biologic agent after trastuzumab. Even with limited success, targeted therapy may be improved by developing new biomarkers. Immune therapy is changing the paradigm of cancer treatment and is presently under active investigation for GC in clinical trials. More evidence supports GC stem cells existence and early stage studies are looking for its potential therapeutic possibilities.

Keywords: Gastric cancer, Novel therapy, Targeted therapy, Immune therapy, Gastric cancer stem cell

Core tip: Advanced gastric cancer (GC) has very poor outcome with chemotherapy remains the main treatment. There is an urgent unmet need to develop novel therapy for GC. Limited success is achieved for targeted therapy after trastuzumab for human epidermal growth factor receptor 2 positive disease. Ramucirumab was recently approved by Food and Drug Administration as a single agent or combined with paclitaxel in refractory advanced GC patients. Immune therapy and GC stem cell research are on the horizon.