Review
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 14, 2006; 12(2): 204-213
Published online Jan 14, 2006. doi: 10.3748/wjg.v12.i2.204
Chemotherapy for gastric cancer
Javier Sastre, Jose Angel García-Saenz, Eduardo Díaz-Rubio
Javier Sastre, Servicio de Oncologia Médica, HCU San Carlos, c/Martín Lagos s/n 28040 Madrid, Spain
Jose Angel García-Saenz, Servicio de Oncologia Médica, HCU San Carlos, c/Martín Lagos s/n 28040 Madrid, Spain
Eduardo Díaz-Rubio, Servicio de Oncologia Médica, HCU San Carlos, c/Martín Lagos s/n 28040 Madrid, Spain
Correspondence to: Javier Sastre, Servicio de Oncologia Médica, HCU San Carlos, c/Martín Lagos s/n 28040 Madrid, Spain. jsastre.hcsc@salud.madrid.org
Telephone: +3491-3303546 Fax: +3491-3303544
Received: May 9, 2005
Revised: June 28, 2005
Accepted: July 8, 2005
Published online: January 14, 2006
Abstract

Metastatic gastric cancer remains a non-curative disease. Palliative chemotherapy has been demonstrated to prolong survival without quality of life compromise. Many single-agents and combinations have been confirmed to be active in the treatment of metastatic disease. Objective response rates ranged from 10-30% for single-agent therapy and 30-60% for polychemotherapy. Results of phase II and III studies are reviewed in this paper as well as the potential efficacy of new drugs. For patients with localized disease, the role of adjuvant and neoadjuvant chemotherapy and radiation therapy is discussed. Most studies on adjuvant chemotherapy failed to demonstrate a survival advantage, and therefore, it is not considered as standard treatment in most centres. Adjuvant immunochemotherapy has been developed fundamentally in Korea and Japan. A meta-analysis of phase III trials with OK-432 suggested that immunochemotherapy may improve survival of patients with curatively resected gastric cancer. Based on the results of US Intergroup 0116 study, postoperative chemoradiation has been accepted as standard care in patients with resected gastric cancer in North America. However, the results are somewhat confounded by the fact that patients underwent less than a recommended D1 lymph node dissection and the pattern of recurrence suggested a positive effect derived from local radiotherapy without any effect on micrometastatic disease.

Neoadjuvant chemotherapy or chemoradiation therapy remains experimental, but several phase II studies are showing promising results. Phase III trials are needed.

Keywords: Gastric cancer; Chemotherapy; Adjuvant treatment