Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3069
Peer-review started: October 17, 2015
First decision: November 13, 2015
Revised: November 27, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 21, 2016
Advanced gastric cancer (aGC), not amenable to curative surgery, is still a burdensome illness tormenting afflicted patients and their healthcare providers. Whereas combination chemotherapy has been shown to improve survival and tumor related symptoms in the frontline setting, second-line therapy (SLT) is subject to much debate in the scientific community, mainly because of the debilitating effects of GC, which would impede the administration of cytotoxic therapy. Recent data has provided sufficient evidence for the safe use of SLT in patients with an adequate performance status. Taxanes, Irinotecan and even some Fluoropyrimidine analogs were found to provide a survival advantage in this subset of patients. Most importantly, quality of life measures were also improved through the use of adequate therapy. Even more pertinent were the findings involving antiangiogenic agents, which would add measurable improvements without significantly jeopardizing the patients’ well-being. Further lines of therapy are cause for much more debate nowadays, but specific targeted agents have shown considerable promise in this context. We herein review noteworthy published data involving the use of additional lines of the therapy after failure of standard frontline therapies in patients with aGC.
Core tip: Patients with advanced gastric cancer who progress after first line therapy are usually perceived as unfit for additional treatments and are therefore denied life prolonging treatments which can also improve quality of life. We herein review the available evidence in favor of undertaking therapeutic interventions in these patients, be it conventional cytotoxic therapies or targeted therapies.