What is the treatment for stage 4 gastric cancer?

From the Guidelines

Treatment for stage 4 gastric cancer should prioritize a multidisciplinary approach focusing on extending life and improving quality of life, with systemic chemotherapy as the primary treatment, often using combination regimens and considering targeted therapy and immunotherapy based on tumor characteristics. The most recent and highest quality study 1 suggests that for patients with unresectable or metastatic disease, best supportive care and palliative management with or without systemic therapy or chemoradiation may be offered, depending on their performance status and prior treatment. Key considerations include:

• Targeted therapies, such as trastuzumab plus chemotherapy for HER2 overexpression–positive tumors 1
• Immunotherapy, such as nivolumab combined with chemotherapy for tumors with PD-L1 expression levels by CPS of $5 or CPS of ,5 1
• Second-line or subsequent therapy options, including ramucirumab, pembrolizumab, and dostarlimab-gxly for specific tumor characteristics 1
• The importance of supportive care, including pain management, nutritional support, and emotional support, to improve quality of life. It's also crucial to consider the patient's overall health, cancer characteristics, and personal preferences when making treatment decisions, aiming to balance survival benefit against side effects and quality of life.

From the FDA Drug Label

1. 4 Gastric Adenocarcinoma Docetaxel Injection in combination with cisplatin and fluorouracil is indicated for the treatment of patients with advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who have not received prior chemotherapy for advanced disease.
2. 4 Gastric Adenocarcinoma For gastric adenocarcinoma, the recommended dose of Docetaxel Injection is 75 mg/m2 as a 1 hour intravenous infusion, followed by cisplatin 75 mg/m2, as a 1 to 3 hour intravenous infusion (both on day 1 only), followed by fluorouracil 750 mg/m2 per day given as a 24-hour continuous intravenous infusion for 5 days, starting at the end of the cisplatin infusion Treatment is repeated every three weeks.

The treatment for stage 4 gastric cancer is Docetaxel Injection in combination with cisplatin and fluorouracil. The recommended dose is:

• Docetaxel Injection: 75 mg/m2 as a 1 hour intravenous infusion
• Cisplatin: 75 mg/m2, as a 1 to 3 hour intravenous infusion (both on day 1 only)
• Fluorouracil: 750 mg/m2 per day given as a 24-hour continuous intravenous infusion for 5 days, starting at the end of the cisplatin infusion Treatment is repeated every three weeks 2.

From the Research

Treatment Options for Stage 4 Gastric Cancer

The treatment for stage 4 gastric cancer typically involves a combination of therapies, with the primary goal of improving survival and quality of life. Some key points to consider include:

• Chemotherapy remains the mainstay of treatment for advanced gastric cancer, with various regimens available, including combination and single-agent therapies 3.
• Targeted therapies, such as trastuzumab and ramucirumab, have shown promise in treating HER-2 positive and other advanced gastric cancer cases 4.
• The choice of chemotherapy regimen depends on various factors, including the patient's performance status, tumor characteristics, and previous treatments.

Chemotherapy Regimens

Some common chemotherapy regimens used to treat stage 4 gastric cancer include:

• Combination regimens, such as epirubicin, oxaliplatin, and capecitabine (EOX) or irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) 5.
• Single-agent therapies, such as docetaxel or irinotecan, which may be used in combination with other agents 3.
• Oral fluoropyrimidines, such as capecitabine or S-1, which may be used in combination with other agents 3, 6.

Targeted Therapies

Targeted therapies, such as:

• Trastuzumab, which is effective in HER-2 positive cases 4, 6.
• Ramucirumab, which has shown promise in treating advanced gastric cancer 4, 6.
• Nivolumab, which has been used in second- and third-line treatments 6.

Second-Line and Subsequent Treatments

For patients who have progressed on first-line treatment, second-line and subsequent treatments may include:

• Modified EOX or FOLFIRI regimens 5.
• Taxanes, such as docetaxel, which may be used in combination with other agents 3, 6.
• Ramucirumab or other targeted therapies, which may be used in combination with chemotherapy 6.