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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2015; 7(11): 303-316
Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.303
Gastric cancer: The times they are a-changin’
Maria Antonietta Satolli, Lucio Buffoni, Rosella Spadi, Ilaria Roato
Maria Antonietta Satolli, Department of Oncology, University of Turin, 10126 Torino, Italy
Lucio Buffoni, Rosella Spadi, Department of Onco-ematology, Medical Oncology, AOU Città della Salute e della Scienza, Molinette, 10126 Turin, Italy
Ilaria Roato, CeRMS, AOU Città della Salute e della Scienza di Torino, Department of Medical Science, University of Turin, 10126 Torino, Italy
Author contributions: Satolli MA designed and wrote the article; Spadi R and Buffoni L analysed literature data; Roato I wrote and revised the article.
Supported by CRT Foudation; and by the Italian Ministry of Health: Ricerca Sanitaria Finalizzata e Giovani Ricercatori 2009, No. GR 2009-1584485.
Conflict-of-interest statement: The authors declare no conflict of interest.
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:
Correspondence to: Ilaria Roato, PhD, CeRMS, AOU Città della Salute e della Scienza di Torino, Department of Medical Science, University of Turin, Via Santena 5, 10126 Torino, Italy.
Telephone: +39-11-6334672 Fax: +39-11-6334672
Received: May 13, 2015
Peer-review started: May 15, 2015
First decision: July 1, 2015
Revised: July 15, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: November 15, 2015

Gastric cancer is the third leading cause of cancer death worldwide. Even though during these last decades gastric cancer incidence decreased in Western countries, it remains endemic and with a high incidence in Eastern countries. The survival in advanced and metastatic stage of gastric cancer is still very poor. Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients. Indeed, the key point is still the selection of patients for the right treatment, on basis of molecular tumor characterization. Since chemotherapy reached a plateau of efficacy for gastric cancer, the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity. Currently, Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erbB2 positive patients, whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer. New perspectives for an effective treatment derived from the immunotherapeutic strategies. Here, we report an overview on gastric cancer treatments, with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.

Keywords: Targeted therapy, Chemotherapy, Gastric cancer, Immunotherapy

Core tip: Gastric cancer, despite its decrease in West Countries, remains one of the most common malignancies worldwide. The prognosis in the advanced setting is often poor even with a multidisciplinary approach, which aims to increase the patients’ survival. The molecular classification of four subtypes of gastric adenocarcinomas (The Cancer Genome Atlas project) allowed a better stratification of patients in clinical trials for targeted therapies. Biologic agents, modulating the immune checkpoints, seem to be the best promising therapeutic approach, opening new perspective for advanced gastric cancer treatment.