New chemotherapy strategies for gastric cancer

Gastric cancer chemotherapy has entered a new era with the introduction of new drugs such as S-1, irinotecan (CPT-11), paclitaxel and docetaxel. Recent phase III studies have indicated that S-1 monotherapy, a remnant reference arm from a previous study, was not inferior to 5-FU alone, and that the combination of S-1 with cisplatin and CPT-11 showed higher efficacy than S-1 alone with tolerable side-effects for advanced and recurrent gastric cancer. In the adjuvant setting, S-1 monotherapy prolonged survival following surgery compared with surgery alone after curative extended (D2) lymph-node dissection for stage II/III gastric cancer. However, some issues remain, such as the sequence of several duplet chemotherapies, treatment following cases of S-1 failure, the relative efficacy of doublet and triplet therapies, and the impact of molecular-targeting.