Chemotherapy options for gastric cancer

Most patients diagnosed with gastric cancer in the United States and the Western World will either present with advanced disease or have recurrence after surgery, requiring discussions of chemotherapy. The evolution of chemotherapy for gastric cancer has been mixed with excitement and disappointment. Multiple single-agent chemotherapies have been shown to be only modestly effective in advanced disease, and the search for the best combination of therapy has been difficult. Contemporary combination therapies for advanced gastric cancer, usually containing 5-fluorouracil (5-FU) and/or cisplatin, demonstrate response rates in the 20% to 40% range, with median survivals between 6 and 12 months. While newer, standard chemotherapeutics, including the taxanes and irinotecan, may offer modest additional benefits, each requires further examination in phase III trials. Among patients with curatively resected disease, postoperative chemoradiotherapy appears to improve overall survival significantly. As a greater understanding of the molecular basis of gastric cancer is gained, the inclusion of biologic-based therapies will hopefully advance our ability to treat patients with gastric cancer more effectively.