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Review
. 2017 Jul 19;2(3):e000206.
doi: 10.1136/esmoopen-2017-000206. eCollection 2017.

Second-line treatments: moving towards an opportunity to improve survival in advanced gastric cancer?

Massimiliano Salati  1 , Katia Di Emidio  1 , Vittoria Tarantino  1 , Stefano Cascinu  1
Affiliations
Review

Second-line treatments: moving towards an opportunity to improve survival in advanced gastric cancer?

Massimiliano Salati et al. ESMO Open. .

Abstract

Gastric cancer is the third leading cause of cancer-related death globally with approximately 723 000 deaths every year. Most patients present with advanced unresectable or metastatic disease, only amenable to palliative systemic treatment and a median survival uncommonly exceeding 12 months. Over the last years, the efficacy of chemotherapy combination has plateaued and the introduction of the anti-human epidermal growth factor receptor 2 trastuzumab has resulted in a limited survival gain in the upfront setting. After this positive experience, first-line treatment with new targeted therapies failed to improve the outcome of advanced gastric cancer. On the contrary, second-line options, including monochemotherapy with taxanes or irinotecan and the anti-vascular endothelial growth factor receptor 2 ramucirumab, either alone or combined with paclitaxel, opened new therapeutic rooms for an ever-increasing number of patients who maintain an acceptable performance status across multiple lines. This article provides an updated overview on the current management of advanced gastric cancer and discusses how the different treatment options available may be best combined to favourably impact the outcome of patients following the logic of a treatment strategy.

Keywords: advanced gastric cancer; ramucirumab; targeted therapy; treatment strategy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Median overall survival by chemotherapy regimen in the first- and the second-line setting for advanced gastric cancer.
Figure 2
Figure 2
Advanced gastric cancer: a tale of two diseases. BSC, best supportive care; ECOG, Eastern Cooperative Oncology Group.
Figure 3
Figure 3
Algorithm for personalised allocation to treatments in patients with advanced gastric cancer. BSC, best supportive care; CF, cisplatin and 5-FU; DCF, docetaxel, cisplatin and fluorouracil; ECF, epirubicin, cisplatin and 5-FU; OS, overall survival; XP, capecitabine and cisplatin, epirubicin, oxaliplatin, and capecitabine, paclitaxel and ramucirumab.
See this image and copyright information in PMC

References

    1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359–E386. 10.1002/ijc.29210 - DOI - PubMed
    1. Van Cutsem E, Sagaert X, Topal B, et al. Gastric cancer. Lancet 2016;388:2654–64. 10.1016/S0140-6736(16)30354-3 - DOI - PubMed
    1. Wagner AD, Unverzagt S, Grothe W, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010;3:CD004064. - PubMed
    1. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010;376:687–97. 10.1016/S0140-6736(10)61121-X - DOI - PubMed
    1. Lordick F, Kang YK, Chung HC, et al. Arbeitsgemeinschaft Internistische Onkologie, EXPAND investigators. capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open label phase 3 trial. Lancet Oncol 2013;14:490–9. - PubMed