From the Guidelines
Gastric cancer management should prioritize a multidisciplinary team approach, with treatment decisions based on tumor characteristics, patient performance status, comorbidities, and preferences, as recommended by the most recent guidelines 1. The management options for gastric cancer depend on the stage of disease and patient factors.
- For early-stage gastric cancer (stages 0-I), endoscopic resection or surgical resection with lymph node dissection (gastrectomy) is the primary treatment.
- For locally advanced disease (stages II-III), multimodality treatment is recommended, typically involving surgical resection combined with perioperative chemotherapy or adjuvant chemoradiation.
- For metastatic disease (stage IV), systemic therapy is the mainstay, including combination chemotherapy regimens such as FOLFOX, XELOX, or DCF.
- Targeted therapies like trastuzumab are added for HER2-positive tumors, while immunotherapy (pembrolizumab) may benefit patients with high microsatellite instability or PD-L1 expression, as supported by recent guidelines 1. Key considerations in gastric cancer management include:
- Multidisciplinary team management is essential for the management of patients with gastric cancer.
- Best supportive care is an integral part of treatment, especially in patients with metastatic and locally advanced gastric cancer.
- Treatment should be individualized based on the patient’s performance status, comorbidities, and HER2 status, and the toxicity profile of each drug, as emphasized in the guidelines 1. Palliative interventions such as stenting for obstruction, radiation for bleeding, or palliative gastrectomy may improve quality of life, and early nutritional support and symptom management are crucial components of comprehensive care, as highlighted in the recent guidelines 1.
From the FDA Drug Label
The efficacy of CYRAMZA was evaluated in REGARD (NCT00917384), a multinational, randomized, double-blind, multicenter study in patients with locally advanced or metastatic gastric cancer (including adenocarcinoma of the GEJ) who previously received platinum- or fluoropyrimidine-containing chemotherapy The major efficacy outcome measure was overall survival (OS). An additional efficacy outcome measure was progression-free survival (PFS). The efficacy of CYRAMZA was also evaluated in RAINBOW (NCT01170663), a multinational, randomized, double-blind study in patients with locally advanced or metastatic gastric cancer (including adenocarcinoma of the GEJ) who previously received platinum- and fluoropyrimidine-containing chemotherapy Docetaxel Injection is a microtubule inhibitor indicated for: Gastric Adenocarcinoma (GC): with cisplatin and fluorouracil for untreated, advanced GC, including the gastroesophageal junction
Management options for gastric cancer include:
- Ramucirumab (CYRAMZA) as a single agent or in combination with paclitaxel for patients with locally advanced or metastatic gastric cancer who previously received platinum- or fluoropyrimidine-containing chemotherapy 2
- Docetaxel in combination with cisplatin and fluorouracil for untreated, advanced gastric adenocarcinoma, including the gastroesophageal junction 3 Key considerations:
- Patient selection based on prior chemotherapy and performance status
- Monitoring for adverse reactions, such as neutropenia, hypersensitivity, and fluid retention
- Dose adjustments as needed to manage toxicity 2, 3
From the Research
Management Options for Gastric Cancer
The management of gastric cancer involves a multidisciplinary approach, including surgery, chemotherapy, and targeted therapies. The following are some of the management options for gastric cancer:
- Surgery: Complete surgical resection offers the chance of cure for localized gastric cancer 4.
- Chemotherapy: Adjuvant chemoradiation with 5-fluorouracil/leucovorin significantly improves disease-free survival and overall survival 4.
- Targeted therapies: Trastuzumab has been shown to improve overall survival in patients with advanced gastric cancer with human epidermal growth factor receptor 2 (HER2) overexpression in combination with chemotherapy 5, 6.
- Multidisciplinary approach: A combination of surgery, chemotherapy, and targeted therapies has been shown to improve outcomes in patients with gastric cancer 7, 8, 4.
Treatment Strategies
The treatment strategies for gastric cancer vary depending on the stage and location of the disease. Some of the treatment strategies include:
- Preoperative chemotherapy and chemoradiation: This approach has been explored in several small randomized studies with encouraging results 4.
- Perioperative chemotherapy: This approach has been shown to improve survival in patients with gastric cancer 4.
- Adjuvant chemoradiation: This approach has been shown to improve disease-free survival and overall survival in patients with gastric cancer 4.
- Targeted therapies: Trastuzumab has been shown to improve overall survival in patients with advanced gastric cancer with HER2 overexpression in combination with chemotherapy 5, 6.
Current Research and Developments
There are ongoing studies and research in the field of gastric cancer management, including:
- Phase II studies: A phase II study of the combination of oxaliplatin, capecitabine, and trastuzumab and chemoradiotherapy in the adjuvant setting in operated patients with HER2-positive gastric or gastroesophageal junction cancer has been conducted 6.
- Multidisciplinary approach: The current multidisciplinary approach to gastric adenocarcinoma includes advances in diagnosis and staging, genomic classification, surgical resection and treatment of peritoneal disease, systemic chemotherapy and chemoradiation, and targeted and immune therapies 8.