Editorial
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 14, 2009; 15(22): 2689-2692
Published online Jun 14, 2009. doi: 10.3748/wjg.15.2689
New perspectives in the treatment of advanced or metastatic gastric cancer
Gerardo Rosati, Domenica Ferrara, Luigi Manzione
Gerardo Rosati, Domenica Ferrara, Luigi Manzione, Medical Oncology Unit, S. Carlo Hospital, Potenza 85100, Italy
Author contributions: Rosati G designed the research, analyzed the data and wrote the paper; Manzione L and Ferrara D participated in this work.
Correspondence to: Gerardo Rosati, MD, Medical Oncology Unit, S. Carlo Hospital, Via P. Petrone, 1, Potenza 85100, Italy. rosatiger@yahoo.com
Telephone: +39-971-612273
Fax: +39-971-613000
Received: March 5, 2009
Revised: April 12, 2009
Accepted: April 19, 2009
Published online: June 14, 2009
Abstract

Metastatic gastric cancer remains an incurable disease, with a relative 5-year survival rate of 7%-27%. Chemotherapy, which improves overall survival (OS) and quality of life, is the main treatment option. Meta-analysis has demonstrated that the best survival results obtained in earlier randomized studies were achieved with three-drug regimens containing a fluoropyrimidine, an anthracycline, and cisplatin (ECF). Although there has been little progress in improving median OS times beyond the 9-mo plateau achievable with the standard regimens, the availability of newer agents has provided some measure of optimism. A number of new combinations incorporating docetaxel, oxaliplatin, capecitabine, and S-1 have been explored in randomized trials. Some combinations, such as epirubicin-oxaliplatin-capecitabine, have been shown to be as effective as (or perhaps more effective than) ECF, and promising early data have been derived for S-1 in combination with cisplatin. One factor that might contribute to extending median OS is the advancement whenever possible to second-line cytotoxic treatments. However, the biggest hope for significant survival advances in the near future would be the combination of new targeted biological agents with existing chemotherapy first-line regimens.

Keywords: Advanced gastric cancer; Biological agents; Chemotherapy