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Advanced gastric adenocarcinoma: optimizing therapy options

Dilsa Mizrak Kaya1, Kazuto Harada1, Yusuke Shimodaira1

  • 1a Department of Gastrointestinal Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.

Expert Review of Clinical Pharmacology
|January 18, 2017
PubMed
Abstract

Insights

Optimal systemic therapy for advanced gastric adenocarcinoma (GAC) involves platinum/fluoropyrimidine combinations, with trastuzumab for HER2-positive tumors. Second-line treatment favors paclitaxel/ramucirumab, guiding advanced GAC management.

Area of Science:

  • Oncology
  • Gastroenterology
  • Pharmacology

Background:

  • Gastric adenocarcinoma (GAC) is a leading cause of cancer mortality globally.
  • Advanced GAC is generally incurable, necessitating effective systemic therapies.
  • Current targeted treatments are limited, highlighting the need for optimized regimens.

Purpose of the Study:

  • To review and define optimal systemic therapy strategies for advanced gastric adenocarcinoma.
  • To consolidate evidence from phase II-III studies for current treatment guidelines.
  • To identify emerging therapeutic targets based on molecular classifications.

Main Methods:

  • Comprehensive literature search of phase II-III studies on advanced GAC.
  • Inclusion of data from major databases (PubMed, clinicaltrials.gov) and oncology society proceedings (ASCO, ESMO).
  • Expert commentary synthesizing findings for clinical application.

Main Results:

  • First-line therapy recommendation: platinum compound plus fluoropyrimidine.
  • Addition of trastuzumab is advised for HER2-positive GAC.
  • Second-line therapy preference: paclitaxel/ramucirumab over ramucirumab monotherapy.

Conclusions:

  • Systemic therapy for advanced GAC requires tailored approaches based on tumor characteristics.
  • Established first- and second-line regimens provide a framework for treatment.
  • Further research into molecular and immune biology is crucial for novel therapeutic targets.
Keywords:
Advanced gastric adenocarcinomafirst line therapymolecular classificationoptimal chemotherapytargeted therapy

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