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Updated: May 29, 2025
Gene Regulation and Targeted Therapy in Gastric Cancer Peritoneal Metastasis: Radiological Findings from Dual Energy CT and PET/CT
Published on: January 22, 2018
Contemporary management of advanced gastric and gastroesophageal adenocarcinomas
Jane E Rogers1, Jaffer A Ajani2
1Department of Pharmacy Clinical Programs, U.T. M.D. Anderson Cancer Center Pharmacy Clinical Programs, Houston, TX, USA.
Introduction:
Gastric and gastroesophageal adenocarcinomas (GEACs) continue to carry a poor prognosis in most patients. New and exciting therapies have entered the treatment landscape in recent years. Prior to these recent approvals, treatment advances had been limited.
Areas Covered:
Important treatment decision biomarkers for metastatic GEAC are microsatellite instability-high/deficient mismatch repair, human epidermal growth factor receptor-2, programmed-death ligand 1, and claudin 18.2 expression among others (such as Epstein Barr Virus (EBV) and agnostic biomarkers). Results of these biomarkers drive therapy decisions. Second-line treatment in most cases is less biomarker driven and needs further progress.
Expert Opinion:
Studies of molecular subsets in GEAC has led to the understanding that these are heterogenous diseases that need to be treated differently. Other biomarkers with targeted therapies are being studied including fibroblast growth factor receptor, trophoblast cell surface antigen-2, and epidermal growth factor receptor. Additionally, epidemiological distinctions are starting to drive therapy such as in EBV in GAC.
Insights
Gastric and gastroesophageal adenocarcinomas (GEACs) have a poor prognosis, but new therapies and biomarkers are improving treatment. Key biomarkers guide first-line therapy, while second-line treatments require further development.
Area of Science:
- Oncology
- Gastroenterology
Background:
- Gastric and gastroesophageal adenocarcinomas (GEACs) are associated with poor patient prognosis.
- Limited treatment advances were observed prior to recent therapeutic approvals.
Purpose of the Study:
- To review current and emerging biomarkers and targeted therapies for GEAC.
- To highlight the heterogeneity of GEAC and the need for personalized treatment approaches.
Main Methods:
- Review of recent clinical studies and therapeutic approvals for GEAC.
- Analysis of established and investigational biomarkers influencing treatment decisions.
Main Results:
- Key biomarkers such as microsatellite instability-high/deficient mismatch repair, human epidermal growth factor receptor-2, programmed-death ligand 1, and claudin 18.2 expression are crucial for first-line metastatic GEAC treatment.
- Emerging biomarkers including fibroblast growth factor receptor, trophoblast cell surface antigen-2, and epidermal growth factor receptor are under investigation.
- Epidemiological factors, like Epstein Barr Virus (EBV) in gastric adenocarcinoma (GAC), are beginning to influence therapy.
Conclusions:
- Advances in understanding GEAC molecular subsets have revealed disease heterogeneity, necessitating tailored treatment strategies.
- Biomarker-driven therapies are transforming GEAC treatment, although second-line options require further progress.
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