Abstract
Gastric cancer remains frequent and one of the most lethal malignancies worldwide.
In this article, we aimed to comprehensively review recent insights in the therapeutic
management of gastric cancer, with focus on the surgical and perioperative management
of resectable forms, and the latest advances regarding advanced diseases.
Surgical improvements comprise the use of laparoscopic surgery including staging laparoscopy,
a better definition of nodal dissection, and the development of hyperthermic intraperitoneal
chemotherapy. The best individualized perioperative management should be assessed
before curative-intent surgery for all patients and can consists in perioperative
chemotherapy, adjuvant chemo-radiation therapy or adjuvant chemotherapy alone. The
optimal timing and sequence of chemotherapy and radiation therapy with respect to
surgery should be further explored.
Patients with advanced gastric cancer have a poor prognosis. Nevertheless, they can
benefit from doublet or triplet chemotherapy combination, including trastuzumab in
HER2-positive patients. Upon progression, second-line therapy can be considered in
patients with good performance status. Although anti-HER2 (trastuzumab) and anti-VEGFR
(ramucirumab) may yield survival benefit, anti-EGFR and anti-HGFR therapies have failed
to improve outcomes. Nevertheless, combination regimens containing cytotoxic drugs
and targeted therapies should be further evaluated; keeping in mind that gastric cancer
biology is different between Asia and the Western countries.
Keywords
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Article info
Publication history
Published online: May 04, 2016
Accepted:
April 14,
2016
Received:
February 21,
2016
Identification
Copyright
© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
