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World J Gastroenterol. Aug 7, 2015; 21(29): 8811-8816
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8811
Chemotherapy beyond second-line in advanced gastric cancer
Sung Min Kim, Se Hoon Park
Sung Min Kim, Se Hoon Park, Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University Samsung Medical Center, Seoul 135-710, South Korea
Author contributions: Kim SM performed the research; Park SH designed the research and wrote the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Se Hoon Park, MD, Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University Samsung Medical Center, Seoul 135-710, South Korea. hematoma@skku.edu
Telephone: +82-2-34103459 Fax: +82-2-34101754
Received: January 22, 2015
Peer-review started: January 24, 2015
First decision: March 10, 2015
Revised: March 23, 2015
Accepted: June 16, 2015
Article in press: June 16, 2015
Published online: August 7, 2015
Abstract

Patients with advanced gastric cancer (AGC) can be treated with multiple lines of chemotherapy. Although several randomized trials have demonstrated the benefit of second-line chemotherapy compared with best supportive care, there is no evidence that further lines of chemotherapy will result in substantial prolongation of survival. Despite this, the practice of offering chemotherapy beyond second-line agents to AGC patients is not uncommon if their performance status is well-preserved and they are willing to receive subsequent active treatments. The choice of chemotherapeutic agents depends on the patient’s prior regimens. However, there are important controversial issues in the salvage setting of AGC, including a subset of patients who may benefit from chemotherapy, that still remain unanswered. This report reviews the available evidence regarding the impact of third- and subsequent lines of chemotherapy on survival and quality of life in patients with AGC.

Keywords: Chemotherapy, Gastric cancer, Salvage

Core tip: There no evidence to date that chemotherapy beyond second-line has a beneficial effect in patients with gastric cancer. The impact of third- and subsequent lines of chemotherapy on survival and quality of life is the subject of this review.