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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11621-11635
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11621
Second-line treatment of metastatic gastric cancer: Current options and future directions
Dheepak Kanagavel, Mikhail Fedyanin, Alexey Tryakin, Sergei Tjulandin
Dheepak Kanagavel, Mikhail Fedyanin, Alexey Tryakin, Sergei Tjulandin, Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia
Author contributions: Kanagavel D, Fedyanin M, Tryakin A and Tjulandin S contributed equally to this work; Tryakin A and Tjulandin S designed research; Kanagavel D and Fedyanin M performed research and analyzed data; and Kanagavel D, Fedyanin M, Tryakin A and Tjulandin S wrote the paper.
Conflict-of-interest statement: The authors have no conflict of interest to report.
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: Sergei Tjulandin, Professor, Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Kashirskoe Shosse 24, Moscow 115478, Russia. stjulandin@mail.ru
Telephone: +7-499-3249844 Fax: +7-499-3249834
Received: April 28, 2015
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
Abstract

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.

Keywords: Metastatic gastric cancer, Second-line chemotherapy, Targeted therapy, Taxane, Irinotecan, Ramucirumab

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.