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Recent Advances in Chemotherapy for Advanced Gastric Cancer

Author(s): Yoon-Koo Kang | Dok Hyun Yoon | Baek-Yeol Ryoo | Min-Hee Ryu

Journal: The Asia-Pacific Journal of Oncology & Hematology
ISSN 1759-6637

Volume: 2;
Issue: 1;
Start page: 67;
Date: 2010;
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Keywords: gastric cancer | chemotherapy | oxaliplatin

Several important issues in the treatment of advanced gastric cancer remain controversial. These include the surgical extent of lymph node dissection, the method of administering adjuvant treatment to patients with resectable disease, and the optimal first-line chemotherapy for unresectable disease. Doublet treatment with fluoropyrimidine plus platinum is the mainstream approach in Asia and the United States, whereas triplet therapy employing a combination of anthracycline, fluoropyrimidine, and platinum is popular in Europe. New agents, including capecitabine, S-1, and oxaliplatin, are as efficacious as the prototype agents, but have more favorable toxicity profiles. Addition of docetaxel to doublet of fluoropyrimidine plus platinum was demonstrated effective, but substantial toxicities were associated with this triplet regimen. Modified DCF regimens appear better tolerated and provide a more clinically useful regimen in practice. The introduction of trastuzumab began the era of targeted therapy for advanced gastric cancer, and trials incorporating bevacizumab, cetuximab, panitumumab, and lapatinib are ongoing. Positive results from the INT-0116, MAGIC, and ACTS-GC trials, using adjuvant treatment, support the value of postoperative chemoradiation, perioperative and postoperative chemotherapy respectively. Various adjuvant treatments are used according to the regional standard of care, differing in terms of the extent of lymph node dissection. The positive results of the AMC 0101 trial highlight the utility of early adjuvant or intraperitoneal chemotherapy as effective adjuvant treatments. Diverse strategies to improve the efficacy of adjuvant therapy are currently under development.

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