Abstract and Introduction
Abstract
Purpose of review: The treatment of gastric cancer has been rapidly evolving with the emergence of new cytotoxic drugs and targeted biologic agents. The purpose of this review is to provide an update in the treatment of localized and metastatic gastric cancer.
Recent findings: Although the overall incidence of gastric cancer has been declining in the United States, the disease continues to be a devastating problem worldwide. Complete surgical resection offers the chance of cure for localized gastric cancer. However, local and distant recurrences are common. Adjuvant chemoradiation with 5-fluorouracil/leucovorin significantly improves disease-free survival and overall survival as demonstrated by the US Intergroup INT-116 study. Most recently, the UK Medical Research Council Adjuvant Gastric trial showed survival benefit with perioperative chemotherapy. Preoperative chemotherapy and chemoradiation have also been explored in several small randomized studies with encouraging results. However, this approach needs to be further confirmed in a large randomized phase III study. Finally, novel molecular targeting agents have been incorporated into the multimodality treatment and shown promising response rate and progression-free survival.
Summary: Gastric cancer remains one of the most clinically challenging cancers among all gastrointestinal malignancies. Mutimodality approach clearly offers survival benefit over surgery alone. In the United States, preoperative chemoradiation or postoperative adjuvant chemoradiation is widely practiced in major centers.
Introduction
Gastric cancer remains one of the most common cancers worldwide. In the United States, approximately 21 000 new cases of gastric cancer will be diagnosed in 2010 with estimated 10 570 deaths attributable to this type of cancer. In contrast to Japan, routine screening of gastric cancer is usually not performed in the United States, primarily, because of its low incidence. Consequently, most patients in the United States present at more advanced stages. The 10-year survival of gastric cancer for all stages of disease is only 20%. Over the past two decades, efforts have been made to improve surgical techniques, adjuvant chemotherapy, preoperative chemotherapy and radiation. However, none of these approaches have demonstrated a potential alteration of the natural history of this disease. The Southwest Oncology Group (SWOG) 9008/INT 0116 trial, as first reported in 2001, showed a survival benefit for adjuvant chemoradiation, which has become the new standard of care in the United States for resected stage IB-IVM0 gastric cancer. Most recently, the results of the UK Medical Research Council Adjuvant Gastric (MAGIC) trial showed survival benefit of perioperative chemotherapy over surgery alone. In this review, we focus on multidisciplinary approaches in managing localized gastric cancer and new development in treating metastatic disease.