The latest advances in chemotherapy for gastrointestinal cancers

During the past decade, there has been much progress in various nonsurgical treatments for gastrointestinal malignancies. Endoscopic mucosal resection (EMR) has been widely used as a standard treatment for early gastrointestinal cancers in Japan. For esophageal cancer, definitive chemoradiotherapy with or without EMR has shown the possibility of results comparable with those of surgery in stage I-III disease and is being evaluated in Japan Clinical Oncology Group (JCOG) studies. Definitive chemoradiotherapy with curative intent for locally advanced (T4/M1a) diseases has had a 5-year survival of 17%. In gastric cancers, although no standard regimen has been established yet, recently developed new agents have achieved higher response rates than before. To establish a new standard, various randomized trials including these new agents are now underway. There has been obvious progress in chemotherapy for colorectal cancer. Newly developed agents such as irinotecan and oxaliplatin have provided significant survival prolongation for metastatic colorectal cancer in randomized trials. In other gastrointestinal malignancies, nonsurgical treatments, including eradication of Helicobacter pylori, chemotherapy, and radiotherapy for primary gastric lymphoma are being evaluated in prospective studies. A new molecular targeting agent, imatinib, has provided significant impact in the treatment of gastrointestinal stromal tumor. To provide these advantages to patients, many more gastrointestinal oncologists are urgently needed in Japan.