[Therapeutic strategy for recurrent gastric cancer and efforts aimed at finding a cure]

Recurrent gastric cancer, in general, is an incurable systemic disease for which the standard of care is systemic chemotherapy. Combination treatment with fluoropyrimidine plus platinum and the addition of trastuzumab for patients with human epidermal growth factor receptor 2(HER2)-positive tumors are widely accepted standard regimens. Fluoropyrimidines include 5-fluorouracil(5-FU), S-1, and capecitabine. There has been an accumulation of data showing the non-inferiority of oxaliplatin to cisplatin. Moreover, the importance of salvage chemotherapy has also been proven in prospective studies. However, retrospective analyses still indicate that the 5-year survival rates associated with metastatic gastric cancer are only a few percent with chemotherapy. To improve survival, newer triplet regimens, such as a combination of docetaxel, cisplatin, and S-1(DCS)and modified folinic acid, 5-FU, oxaliplatin, and irinotecan(modified FOLFOXIRI), are now under clinical investigation. Despite the limitations of retrospective data, surgical resection for gastric cancer liver metastases appears to be beneficial in carefully selected patients. Currently, the implication of surgical resection for metastatic gastric cancer is being evaluated in clinical trials. These efforts will result in further clinical advances with tailored treatment strategies.