Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11621
Peer-review started: May 5, 2015
First decision: July 13, 2015
Revised: August 14, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 7, 2015
Gastric cancer remains one among the leading causes of cancer-related deaths, regardless of its decreasing incidence and newly available treatment options. Most patients present at an advanced stage and are treated with upfront systemic chemotherapy. Those patients receiving first-line therapy may initially respond to treatment, but many of them relapse over time. In such condition, second-line treatment for disease progression remains the only available option. Although there exists no standard approach in the second-line setting, several phase III trials have shown modest survival benefit in patients receiving irinotecan, taxane and ramucirumab over the best supportive care or active agents. This review analyzes the currently available treatment regimens and future directions of research in the second-line setting for metastatic gastric cancer with the best available evidence. Additionally, the prognostic factors that influence patient survival in those receiving second-line therapy are discussed.
Core tip: This systematic review has analyzed the currently available treatment options with chemotherapy and targeted agents in the second-line treatment of metastatic gastric cancer. In addition, this review has discussed the future directions of research and the prognostic factors that influence patient survival in those receiving second-line therapy for metastatic gastric cancer.