Advancing pharmacological treatment options for advanced gastric cancer

Abstract

Introduction: Gastric cancer is the third most common cause of cancer-related deaths worldwide. Improvement of conventional chemotherapy has been modest in the past decades.

Areas covered: We review recent important studies of metastatic or recurrent gastric cancer. For human epidermal growth factor receptors 2 (HER2) negative cancer, standard treatments are combinations of fluoropyrimidine and platinum with or without epirubicin or docetaxel in first-line therapy. Controversy exists regarding the use of triplet chemotherapies due to their toxicity. For HER2 positive cancer, standard treatments are combinations of fluoropyrimidine and cisplatin with trastuzumab. As second- or third-line treatment, taxanes or irinotecan prolonged survival compared with best supportive care alone, but the extension of overall survival was only 1 – 2 months. A recent study demonstrated that ramucirumab plus paclitaxel improved survival as a second-line therapy.

Expert opinion: Most trials have failed to demonstrate a benefit of targeted agents. It is important to identify predictive biomarkers to enrich an appropriate patient population for targeted agents such as HER2 status for trastuzumab.

Keywords:

• chemotherapy
• gastric cancer
• immune checkpoint inhibitor
• metastatic
• recurrent
• targeted therapy

Declaration of interest

Y Yamada has received honoraria from Chugai Pharmaceutical, Taiho Pharmaceutical, and Yakult Honsha; and research funding from Chugai Pharmaceutical, Taiho Pharmaceutical, AstraZeneca, Novartis, Merck Serono, and Daiichi-Sankyo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Writing assistance from NAI Inc. was utilized in the production of this manuscript.

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