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Farmacoterapia para pacientes con cáncer gástrico previamente tratados: opciones actuales y desarrollos futuros

Seiya Sato¹, Izuma Nakayama¹, Kohei Shitara¹

¹Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Expert review of clinical pharmacology

|August 25, 2025

Resumen

La quimioterapia prolonga la supervivencia en el cáncer gástrico avanzado (AGC). Están surgiendo nuevas terapias dirigidas y conjugados anticuerpo-fármaco, y se espera que los tratamientos basados en biomarcadores lideren la atención futura para los pacientes con AGC tratados previamente.

Área de la Ciencia:

En el campo de la oncología
Investigación del cáncer gastrointestinal
Análisis de ensayos clínicos

Sus antecedentes:

La quimioterapia ha demostrado su eficacia para prolongar la supervivencia en pacientes con cáncer gástrico avanzado (CGA) previamente tratado.
Los agentes citotóxicos establecidos para la AGC incluyen paclitaxel, irinotecan y trifluridina/tipiracil.
Los agentes antiangiogénicos e inmunoterapéuticos como el ramucirumab y el pembrolizumab también se utilizan en función de biomarcadores específicos.

Objetivo del estudio:

Revisar la evidencia de ensayos clínicos históricos y actuales para el cáncer gástrico avanzado previamente tratado.
Discutir los ensayos clínicos en curso y las direcciones futuras en el desarrollo del tratamiento de AGC.
Destacar la creciente importancia de las terapias dirigidas en el tratamiento del cáncer gástrico avanzado.

Principales métodos:

Revisión sistemática de los datos de ensayos clínicos para el cáncer gástrico avanzado.
Análisis de agentes terapéuticos establecidos y emergentes, incluidas las modalidades citotóxicas, dirigidas y nuevas.
Debate sobre las investigaciones en curso y las perspectivas de tratamiento en el futuro.

Principales resultados:

El trastuzumab deruxtecan (T-DXd) es una terapia molecular dirigida clave para el AGC HER2-positivo.
La terapia de anticuerpos dirigidos a la claudina-18.2 está establecida en el tratamiento de primera línea y se está investigando en líneas posteriores.
Los objetivos prometedores incluyen TROP2, CAPRIN-1 y KRAS, con conjugados anticuerpo-fármaco y anticuerpos bispecíficos en desarrollo.

Conclusiones:

Las terapias dirigidas están revolucionando el tratamiento del cáncer gástrico avanzado, especialmente para los pacientes tratados previamente.
Los enfoques innovadores como los conjugados anticuerpo-fármaco y los anticuerpos bispecíficos son muy prometedores.
Se prevé que las estrategias de tratamiento basadas en biomarcadores se conviertan en el estándar de atención en el cáncer gástrico avanzado.

Palabras clave:

Cáncer gástrico el biomarcador la quimioterapia Cáncer gastroesofágico inmunoterapia tratamiento dirigido

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