scholarly journals Immunotherapy in Advanced Gastric Cancer: An Overview of the Emerging Strategies

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Helena Magalhães ◽  
Mário Fontes-Sousa ◽  
Manuela Machado
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Median Overall Survival ◽  
Systemic Disease ◽  
Treatment Strategies ◽  
Public Health Problem ◽  
Molecular Classification ◽  
Current Evidence ◽  
Curative Intent

Gastric cancer (GC) remains a public health problem, being the fifth most common cancer worldwide. In the western countries, the majority of patients present with advanced disease. Additionally, 65 to 75% of patients treated with curative intent will relapse and develop systemic disease. In metastatic disease, systemic treatment still represents the state of the art, with less than a year of median overall survival. The new molecular classification of GC was published in 2014, identifying four distinct major subtypes of gastric cancer, and has encouraged the investigation of new and more personalized treatment strategies. This paper will review the current evidence of immunotherapy in advanced gastric cancer.

scholarly journals Effect of RECIST revision on classification of target lesions and overall response in advanced gastric cancer patients

2012 ◽  
Vol 16 (3) ◽  
pp. 324-328 ◽  
Author(s):  
Nozomu Fuse ◽  
Emiko Nagahisa-Oku ◽  
Toshihiko Doi ◽  
Takahide Sasaki ◽  
Shogo Nomura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Cancer Patients ◽  
Overall Response ◽  
Gastric Cancer Patients

scholarly journals The Efficacy and Safety of (Neo)Adjuvant Therapy for Gastric Cancer: A Network Meta-analysis

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 80 ◽  
Author(s):  
Tom van den Ende ◽  
Emil ter Veer ◽  
Mélanie Machiels ◽  
Rosa Mali ◽  
Frank Abe Nijenhuis ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Curative Resection ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Perioperative Chemotherapy ◽  
Curative Intent ◽  
Radio Therapy ◽  
Credible Intervals ◽  
Resectable Gastric Cancer

Background: Alternatives in treatment-strategies exist for resectable gastric cancer. Our aims were: (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to August 2017 for randomized-controlled-trials on the curative treatment of resectable gastric cancer. We performed two network-meta-analyses (NMA). NMA-1 compared perioperative, neoadjuvant and adjuvant strategies only if there was a direct comparison. NMA-2 compared different adjuvant chemo(radio)therapy regimens, after curative resection. Overall-survival (OS) and disease-free-survival (DFS) were analyzed using random-effects NMA on the hazard ratio (HR)-scale and calculated as combined HRs and 95% credible intervals (95% CrIs). Results: NMA-1 consisted of 9 direct comparisons between strategies for OS (14 studies, n = 4187 patients). NMA-2 consisted of 16 direct comparisons between adjuvant chemotherapy/chemoradiotherapy regimens for OS (37 studies, n = 10,761) and 14 for DFS (30 studies, n = 9714 patients). Compared to taxane-based-perioperative-chemotherapy, surgery-alone (HR = 0.58, 95% CrI = 0.38–0.91) and perioperative-chemotherapy regimens without a taxane (HR = 0.79, 95% CrI = 0.58–1.15) were inferior in OS. After curative-resection, the doublet oxaliplatin-fluoropyrimidine (for one-year) was the most efficacious adjuvant regimen in OS (HR = 0.47, 95% CrI = 0.28–0.80). Conclusions: For resectable gastric cancer, (1) taxane-based perioperative-chemotherapy was the most promising treatment strategy; and (2) adjuvant oxaliplatin-fluoropyrimidine was the most promising regimen after curative resection. More research is warranted to confirm or reproach these findings.

scholarly journals Molecular classification of gastric cancer

2016 ◽  
Vol 27 (5) ◽  
pp. 763-769 ◽  
Author(s):  
N.-Y. Chia ◽  
P. Tan
Keyword(s):  
Gastric Cancer ◽  
Molecular Classification

scholarly journals Evidence Based Surgical Approach to Locally Advanced Gastric Cancer

2019 ◽  
Vol 17 (2) ◽  
pp. 133-140
Author(s):  
Binay Thakur ◽  
Mukti Devkota ◽  
Amit Sharma ◽  
Manish Chaudhary
Keyword(s):  
Gastric Cancer ◽  
Soviet Union ◽  
Advanced Gastric Cancer ◽  
Former Soviet Union ◽  
Locally Advanced ◽  
Population Level ◽  
Multimodality Treatment ◽  
Current Evidence ◽  
Curative Surgery ◽  
Locally Advanced Gastric Cancer

Gastric cancer is endemic in China, Japan, Korea, Brazil and Former Soviet Union. Patients are diagnosed usually in locally advanced stage. Endoscopy, Positron Emission Therapy- Computed Tomography, Endoscopic ultrasound and staging laparoscopy are the tools for proper evaluation of such patients. Locally advanced gastric cancer (T2-4N0 or TanyN+) requires multimodality treatment including surgery. Resection is the cornerstone of cure for gastric adenocarcinoma; however, several aspects of surgical intervention remain controversial or are suboptimally applied at a population level. Current evidence shows a D2 gastrectomy has got the best survival results. At least 15 lymph nodes should be assessed for adequate staging. Laparoscopic resections should be performed to the same standards as those for for open resections, by surgeons who are experienced in both advanced laparoscopic surgery and gastric cancer management.Keywords: Curative surgery; gastrectomy; stomach neoplasms.

scholarly journals New therapeutic options opened by the molecular classification of gastric cancer

2018 ◽  
Vol 24 (18) ◽  
pp. 1942-1961 ◽  
Author(s):  
Mihaela Chivu-Economescu ◽  
Lilia Matei ◽  
Laura G Necula ◽  
Denisa L Dragu ◽  
Coralia Bleotu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Molecular Classification ◽  
Therapeutic Options

Chemotherapy with FOLFOX IV in advanced gastric cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14112-14112
Author(s):  
M. A. Garrido. ◽  
G. Melgoza ◽  
H. Galindo ◽  
J. Madrid ◽  
C. Sanchez ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Median Overall Survival ◽  
Lung Metastases ◽  
Stage Iv ◽  
Phase Iii ◽  
First Line ◽  
Phase Iii Trial ◽  
Low Toxicity ◽  
Grade 3

14112 Background: Gastric cancer is the first cause of mortality for cancer in Chile. 65% is observed in advanced form and the median survival without surgery is 5,4 months. We hypothesised that chemotherapy and specially FOLFOX IV is an active regimen and has low toxicity in patient with advanced gastric cancer. The main evaluated objectives were: response, toxicity and survival of patient with advanced gastric cancer. Methods: Patients with gastric adenocarcinoma, stage IV that accepted chemotherapy with FOLFOX IV in any time of evolution were included. The evaluation of response was obtained with CT scan every two month. The characteristics of patients, chemotherapy responses, toxicity and global survival were analysed. Results: Between November 2003 and October 2005, 20 patients were included, the median age was 51,5 years (range 28–67), 80% male. Hepatic, peritoneal and lung metastases were the principal places of dissemination. The response rate in first line was: PR 66%, SD 17%, with overall response of 83% (12 patients). In second line the response was: PR 37%, SD 63% (8 patients). The average of treatment was 5,5 months. The median of response was 5 months (2–12). The median overall survival was 12 months. 50% of patients showed toxicity; digestive grade 2 in 2 patients, neurological grade 2 in 4 patients and only 1 patient showed grade 3 toxicity. Conclusions: FOLFOX IV is an active chemotherapy regiment with low toxicity profile in advanced gastric cancer. With these results we propose a Phase III trial would be feasible to perform. No significant financial relationships to disclose.

Randomized phase III trial of standard D2 versus D2 + para-aortic lymph node (PAN) dissection (D) for clinically M0 advanced gastric cancer: JCOG9501

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. LBA4015-LBA4015 ◽  
Author(s):  
M. Sasako ◽  
T. Sano ◽  
S. Yamamoto ◽  
A. Nashimoto ◽  
A. Kurita ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Disease Free Survival ◽  
Operation Time ◽  
Hazard Ratio ◽  
Phase Iii ◽  
Rank Test ◽  
R0 Resection ◽  
Eligibility Criteria ◽  
Curative Intent

LBA4015 Background: The INT-0116 study proved the efficacy of radiochemotherapy after R0 resection for gastric cancer and thus the importance of the local control and the insufficiency of D0/1 surgery. Recently D2 surgery was for the first time proven to improve the survival compared with D1 in a Taiwanese RCT (Lancet Oncol 2006). In our study, D2+PAND was compared with D2 in a RCT. Low operative mortality has been reported (Sano et al. J Clin Oncol 2004) and we now present the survival results. Methods: Eligibility criteria included; histologically proven adenocarcinoma, cT2b-T4, cM0, no macroscopic metastasis to the PAN, negative lavage cytology, adequate organ function, and age <76. Linitis plastica was excluded. Eligible pts were randomly assigned to D2 with or without PAND during surgery. All patients were followed without adjuvant therapy until recurrence. The primary endpoint was overall survival (OS) to be compared by stratified log-rank test. Assuming 256 eligible pts in each arm, the study had 75% power to detect 0.73 hazard ratio for D2+PAND to D2 in OS at 0.05 one-sided alpha. Results: Between 07/1995 and 04/2001, 523 pts were randomized (263 to D2 and 260 to D2+PAND). Baseline characteristics were well balanced between the arms. At the time of the final analysis on 23/03/06, 191 (96 and 95, in D2 and D2+PAND, respectively) had died. The 3- and 5-year OS were 76% and 69% in D2 and 76% and 70% in D2+PAND, respectively (p = 0.57, Hazard ratio was 1.03 (95% CI: 0.77–1.37)). Disease free survival did not show any difference between the groups as well. Median operation time was 63 minutes longer and median blood loss was 230 ml larger in D2+PAND than in D2. There was no difference in the incidence of major surgical complications and hospital mortality (0.8% in both arms). Conclusions: D2 or D2+PAND could be carried out safely and showed excellent survival for advanced gastric cancer treated with curative intent. PAND could not improve the survival achieved by D2. General use of PAND should be avoided. No significant financial relationships to disclose.

scholarly journals ADJUVANT CHEMORADIOTHERAPY AFTER SUBTOTAL OR TOTAL GASTRECTOMY AND D2 LIMPHADENECTOMY INCREASES SURVIVAL IN ADVANCED GASTRIC CANCER?

2019 ◽  
Vol 32 (4) ◽  
Author(s):  
Nelson Adami ANDREOLLO ◽  
Eric DRIZLIONOKS ◽  
Valdir TERCIOTI-JUNIOR ◽  
João de Souza COELHO-NETO ◽  
José Antonio Possato FERRER ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Adjuvant Treatment ◽  
Subtotal Gastrectomy ◽  
Adjuvant Chemoradiotherapy ◽  
Curative Intent ◽  
Number Of Patients ◽  
Significant Difference

ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.

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