Chemotherapy of gastric cancer

Overall, gastric cancer appears to be the most chemotherapy-responsive gastrointestinal neoplasm. A number of single agents have been demonstrated to produce partial responses and combination chemotherapy produces response rates of 30-50% with some complete responses. Completed and ongoing adjuvant studies, employing multiple drug regimens have not demonstrated convincing evidence of survival advantage. Combined modality treatment appears to offer an advantage for patients with small amounts of local or regional disease. Intraoperative radiation therapy may also be useful, although initial uncontrolled studies require confirmation. Clearly, there is a need for new agents with higher response rates to be used in combination and/or with other therapeutic modalities. The timing of chemotherapy needs to be addressed with earlier postoperative initiation of therapy or preoperative chemotherapy. Lastly, the areas of pharmacologic modulation of chemotherapy and biological response modification need to be explored in the treatment of this disease.