Recent advances in the management of gastric adenocarcinoma patients [version 1; peer review: 2 approved]

• Published in: F1000 research 2018, Vol.7, p.1365
• Main Authors: Harada, Kazuto, Lopez, Anthony, Shanbhag, Namita, Badgwell, Brian, Baba, Hideo, Ajani, Jaffer
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Cancer therapies; Chemoradiotherapy; Chemotherapy; Clinical trials; Combined Modality Therapy; Confidence intervals; Dissection; Endoscopy; Epidermal growth factor; Gastric cancer; Genomes; Geographical variations; Histology; Humans; Immunotherapy; Medical prognosis; Metastases; Metastasis; Microsatellite instability; Molecular Targeted Therapy; Monoclonal antibodies; Mutation; Paclitaxel; Patients; PD-L1 protein; Pembrolizumab; Precision Medicine; Radiation therapy; Review; Stomach Neoplasms - pathology; Stomach Neoplasms - therapy; Surgery; Targeted cancer therapy; Trastuzumab; Tumor cells; Vascular endothelial growth factor
• ISSN: 2046-1402; 2046-1402
• DOI: 10.12688/f1000research.15133.1

Gastric adenocarcinoma (GAC) is one of the most aggressive malignancies and has a dismal prognosis. Therefore, multimodality therapies to include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy are needed to provide advantage. For locally advanced GAC (>cT1B), the emerging strategies have included preoperative chemotherapy, postoperative adjuvant chemotherapy, and (occasionally) postoperative chemoradiation in various regions. Several novel therapies have been assessed in clinical trials, but only trastuzumab and ramucirumab (alone and in combination with paclitaxel) have shown overall survival advantage. Pembrolizumab has been approved by the US Food and Drug Administration on the basis of response rate only for patients with microsatellite instability (MSI-H) or if PD-L1 expression is positive (≥1% labeling index in tumor/immune cells in the presence of at least 100 tumor cells in the specimen). Nivolumab has been approved in Japan on the basis of a randomized trial showing significant survival advantage for patients who received nivolumab compared with placebo in the third or later lines of therapy. The cure rate of patients with localized GAC in the West is only about 40% and that for metastatic cancer is very poor (only 2-3%). At this stage, much more target discovery is needed through molecular profiling. Personalized therapy of patients with GAC remains a challenge.