Chemotherapy of gastric cancer: a review

Gastric cancer remains a common malignancy with poor prognosis. Although surgery is possible in 80 to 90% of patients, less than 50% will have resectable disease and most of these patients will have recurrences. Many chemotherapy studies have been performed in patients with advanced carcinoma of the stomach. At least five conventional agents have been identified as having modest to moderate activity. It is unclear whether combination chemotherapy is more effective in terms of survival rate. Several new chemotherapeutic agents are being studied for gastric cancer, but none have yet proven to be more useful than conventional drugs. Although the rationale for adjuvant chemotherapy in gastric cancer is well established, a substantial number of prospective, controlled randomized trials in Western countries have failed to consistently demonstrate benefit. Thus, for patients with resectable disease who remain at high risk for recurrence, the preferred option is entry into a carefully planned investigation. In the absence of a research protocol, there are no data to support the routine use of chemotherapy in an adjuvant setting for stomach cancer.