[Chemotherapy in the treatment of gastric cancer]

Despite the reduced incidence and mortality, gastric cancer remains the second leading cause of cancer death in Korea. Metastatic gastric cancer is regarded as an incurable condition, and chemotherapy is usually accepted as standard palliation. A number of randomized studies were performed comparing supportive care strategies with intravenous chemotherapy. The results demonstrated that systemic treatment can actually improve overall survival and quality of life to a certain extent. However, there is no agreement for standard of treatment in this setting. Recently, a number of newer compounds such as taxanes, topoisomerase I inhibitors and oral fluoropyrimidines have been intensively studied. The surgical resection still remains as the cornerstone of gastric cancer treatment. However, the high rate of recurrence and poor survival after surgery provides a rationale for the early use of adjuvant treatment. A large intergroup study (INT-0116) showed that combined chemoradiation following to gastric resection improves median time to relapse and overall survival. Future advances in the therapy of advanced and resectable gastric cancers may come from the application of new cytotoxic and molecularly targeted agents such as growth factor receptor antagonists and anti-angiogenesis agents.