Archive of Oncology (Jan 2003)
Advances in systemic treatment of metastatic gastric cancer
Abstract
Gastric carcinoma is a frequent malignancy throughout the world and endemic in many of its regions. Advanced gastric carcinoma is often diagnosed. Patients with advanced gastric cancer have a median survival of 6-8 months and chemotherapy is palliative. Even in patients with resectable disease 5-year survival is generally poor. Chemotherapy is usually accepted as standard treatment for advanced disease. None of existing chemotherapy regimens has been established as standard, and chemotherapy within the controlled clinical trials is still the best option for advanced gastric cancer patients. In some trials a response rate of more than 50% has been achieved for multidrug regimens. It seems that the important story in gastric cancer is not told by focusing on the response rates in serial phase II or even phase III trials. In this disease, the success with respect to high response rates has been virtually canceled out by the fact that tumor shrinkage seems to be evanescent. There has not yet been a regimen reported that leads to a 50% survival probability at one year. A 2-year survival rate of 14% is considered noteworthy as a "long-term survival". Toxicity including nausea, vomiting, asthenia, anorexia, neutropenia, and treatment related morbidity, in patients with gastric cancer remain substantial issues, especially with multidrug therapy. Among the newer agents, oral fluoropyrimidines, taxanes, irinotecan and oxaliplatin appear to be relevant candidates for improved palliation and extension of survival. Further clinical studies are certainly needed to define the optimal role for these drugs. Gastric carcinoma has a variety of molecular abnormalities. Many of these molecules can be targeted theoretically, however, practical applications are yet to be fully developed. Limited number of studies has been done using specific targets against gastric carcinoma.
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