Published online Jan 24, 2025. doi: 10.5306/wjco.v16.i1.100943
Revised: September 26, 2024
Accepted: October 22, 2024
Published online: January 24, 2025
Processing time: 60 Days and 15.8 Hours
Gastric cancer (GC) and gastroesophageal junction cancer (GEJC) represent a significant burden globally, with complications such as overt bleeding (OB) fur
Core Tip: This editorial discusses a recent study addressing the management of gastric cancer (GC) patients with advanced GC and overt bleeding, focusing on survival out
- Citation: Qayed E. Optimizing care for gastric cancer with overt bleeding: Is systemic therapy a valid option? World J Clin Oncol 2025; 16(1): 100943
- URL: https://www.wjgnet.com/2218-4333/full/v16/i1/100943.htm
- DOI: https://dx.doi.org/10.5306/wjco.v16.i1.100943
Gastric cancer (GC) is the fifth most common malignancy worldwide and the third leading cause of cancer-related mortality. The prognosis for GC remains poor, particularly in advanced stages, where complications such as overt bleeding (OB) can significantly impact the course of treatment and patient survival. OB in GC patients is a clinical challenge due to the associated risks of rapid deterioration, reduced quality of life, and limited therapeutic options. Previous studies have explored various strategies to manage OB, including endoscopic interventions, palliative ra
OB is a frequent and severe complication in GC and gastroesophageal junction cancer (GEJC) patients, affecting approximately 10%-15% of these patients. The bleeding typically results from tumor invasion into blood vessels, leading to hemorrhage that can be life-threatening if not promptly managed[3,4]. The prognosis for patients with OB is generally worse than for those without bleeding, with studies reporting a median overall survival (mOS) as low as 3-6 months following the onset of bleeding[5,6].
Endoscopic management has recently emerged as a possible hemostatic intervention for controlling tumor bleeding in patients with inoperable GC. Endoscopic techniques, including hemostasis using argon plasma coagulation (APC) and hemostatic spray therapy, have been developed to manage bleeding effectively and improve patients' quality of life[7]. Kim and Choi[8] highlighted the role of endoscopic management in such scenarios, emphasizing its effectiveness. Endoscopic hemostasis is particularly beneficial in cases where the bleeding source is accessible, and the tumor is lo
Despite the high success rates of endoscopic hemostasis, rebleeding rates remained a concern, ranging from 16%-80%. Consequently, the decision to initiate systemic therapy in patients with ongoing but relatively stable bleeding presents a significant clinical dilemma.
The study by Yao et al[10] included a cohort of 171 patients diagnosed with advanced or metastatic GC/GEJC treated at Peking University Third Hospital between January 2013 and December 2021. The study population consisted of patients who received systematic therapy, including chemotherapy, targeted therapy, or immune checkpoint inhibitors, as initial anticancer treatment. Among the included patients, 32 had OB before treatment (OBBT), while 61 did not. Propensity score matching was used to ensure balanced baseline characteristics between the two groups, allowing for a more accurate comparison of outcomes.
All patients received systematic anticancer therapy, with the majority receiving a chemotriplet or chemodoublet-based regimen. The study found no significant difference in the overall survival between patients with OBBT and those without OBBT, with a mOS of 15.2 months and 23.7 months, respectively. However, patients who developed OB after treatment (OBAT) had a significantly worse mOS of 11.4 months, compared to 23.7 months for those without OBAT. The incidence of grade 3-4 treatment-related adverse events was similar between the OBBT and non-OBBT groups, indicating that systematic therapy did not increase toxicity in patients with OB.
The study also identified several factors associated with an increased risk of OBAT, including a history of alcohol consumption, tumor location in the gastric body, and poor radiographic response to initial therapy. These findings underscore the importance of careful patient selection and monitoring during treatment to minimize the risk of bleeding-related complications.
The study by Yao et al[10] has several important implications for clinical practice. First, the findings suggest that sy
The role of endoscopic management in stabilizing patients before systematic therapy cannot be overstated. Endoscopic hemostasis should be considered a first-line intervention in patients presenting with OB, particularly when the bleeding source is accessible and amenable to endoscopic control[8]. By controlling bleeding early, clinicians can improve the safety and efficacy of subsequent systematic treatments, potentially extending survival and enhancing the quality of life for these high-risk patients. However, in patients with ongoing but manageable bleeding-such as stable vital signs with intermittent OB and a gradual decline in hemoglobin-systemic therapy should be considered. Withholding systemic therapy in these cases may not be justified.
Looking forward, future research should focus on the integration of novel therapeutic agents, such as immune checkpoint inhibitors and targeted therapies, with existing treatment modalities to improve outcomes for patients with GC and OB. The development of predictive biomarkers for bleeding risk could also help in the stratification of patients and the customization of treatment plans[11,12]. Future research should aim to clarify the optimal management strategies for patients with advanced inoperable GC who are being considered for systemic therapy. Key questions include deter
Innovations in endoscopic technology, such as the use of advanced imaging techniques and more precise therapeutic tools, may further enhance the effectiveness of endoscopic management in inoperable GC. Exploring the combination of endoscopic hemostasis with other modalities, such as radiofrequency ablation or photodynamic therapy, could offer new avenues for controlling tumor bleeding while minimizing the risk of rebleeding[8,9]. Prospective multicenter studies with larger patient cohorts are needed to validate the findings of Yao et al[10] and to explore the long-term benefits of in
The study by Yao et al[10] provides important insights into the management of GC/GEJC patients with OB, emphasizing that systematic therapy can be safe and effective even in patients with OB treatment. However, the development of OB during or after treatment is associated with significantly worse outcomes, underscoring the need for careful patient se
1. | Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-249. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 50630] [Cited by in F6Publishing: 53636] [Article Influence: 17878.7] [Reference Citation Analysis (124)] |
2. | Nevo Y, Ferri L. Current management of gastric adenocarcinoma: a narrative review. J Gastrointest Oncol. 2023;14:1933-1948. [PubMed] [DOI] [Cited in This Article: ] [Cited by in F6Publishing: 1] [Reference Citation Analysis (0)] |
3. | Minhem MA, Nakshabandi A, Mirza R, Alsamman MA, Mattar MC. Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions. World J Gastrointest Endosc. 2021;13:391-406. [PubMed] [DOI] [Cited in This Article: ] [Cited by in CrossRef: 7] [Cited by in F6Publishing: 7] [Article Influence: 2.3] [Reference Citation Analysis (3)] |
4. | Kerbage A, Hamadeh N, Hashash JG, Rockey D, Barada K. Overt gastrointestinal bleeding in patients with cancer: Clinical characteristics and outcomes. Am J Med Sci. 2024;368:346-354. [PubMed] [DOI] [Cited in This Article: ] [Reference Citation Analysis (0)] |
5. | Song IJ, Kim HJ, Lee JA, Park JC, Shin SK, Lee SK, Lee YC, Chung H. Clinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer. J Gastric Cancer. 2017;17:374-383. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 10] [Cited by in F6Publishing: 10] [Article Influence: 1.4] [Reference Citation Analysis (0)] |
6. | Takeda K, Sakayauchi T, Kubozono M, Katagiri Y, Umezawa R, Yamamoto T, Ishikawa Y, Takahashi N, Suzuki Y, Kishida K, Jingu K. Palliative radiotherapy for gastric cancer bleeding: a multi-institutional retrospective study. BMC Palliat Care. 2022;21:52. [PubMed] [DOI] [Cited in This Article: ] [Cited by in F6Publishing: 6] [Reference Citation Analysis (0)] |
7. | Kawabata H, Hitomi M, Motoi S. Management of Bleeding from Unresectable Gastric Cancer. Biomedicines. 2019;7. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 12] [Cited by in F6Publishing: 16] [Article Influence: 3.2] [Reference Citation Analysis (0)] |
8. | Kim YI, Choi IJ. Endoscopic management of tumor bleeding from inoperable gastric cancer. Clin Endosc. 2015;48:121-127. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 28] [Cited by in F6Publishing: 38] [Article Influence: 4.2] [Reference Citation Analysis (0)] |
9. | Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Cooke D, Corvera C, Das P, Enzinger PC, Enzler T, Fanta P, Farjah F, Gerdes H, Gibson MK, Hochwald S, Hofstetter WL, Ilson DH, Keswani RN, Kim S, Kleinberg LR, Klempner SJ, Lacy J, Ly QP, Matkowskyj KA, McNamara M, Mulcahy MF, Outlaw D, Park H, Perry KA, Pimiento J, Poultsides GA, Reznik S, Roses RE, Strong VE, Su S, Wang HL, Wiesner G, Willett CG, Yakoub D, Yoon H, McMillian N, Pluchino LA. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20:167-192. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 41] [Cited by in F6Publishing: 672] [Article Influence: 336.0] [Reference Citation Analysis (0)] |
10. | Yao YH, Zhang H, Xiao Y, Liu ZT, Shi YY, Yu JY, Li Q, Cao BS. Systematic treatment in gastric cancer patients with overt bleeding: A propensity score matching analysis. World J Clin Oncol. 2024;15:1177-1187. [PubMed] [DOI] [Cited in This Article: ] [Reference Citation Analysis (0)] |
11. | Janjigian YY, Shitara K, Moehler M, Garrido M, Salman P, Shen L, Wyrwicz L, Yamaguchi K, Skoczylas T, Campos Bragagnoli A, Liu T, Schenker M, Yanez P, Tehfe M, Kowalyszyn R, Karamouzis MV, Bruges R, Zander T, Pazo-Cid R, Hitre E, Feeney K, Cleary JM, Poulart V, Cullen D, Lei M, Xiao H, Kondo K, Li M, Ajani JA. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet. 2021;398:27-40. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 1201] [Cited by in F6Publishing: 1466] [Article Influence: 488.7] [Reference Citation Analysis (0)] |
12. | Salehifar E, Avan R, Janbabaei G, Mousavi SK, Faramarzi F. Comparison the Incidence and Severity of Side Effects Profile Of FOLFOX and DCF Regimens in Gastric Cancer Patients. Iran J Pharm Res. 2019;18:1032-1039. [PubMed] [DOI] [Cited in This Article: ] [Cited by in F6Publishing: 3] [Reference Citation Analysis (0)] |