Published online May 28, 2016. doi: 10.3748/wjg.v22.i20.4812
Peer-review started: February 25, 2016
First decision: March 31, 2016
Revised: April 8, 2016
Accepted: April 20, 2016
Article in press: April 20, 2016
Published online: May 28, 2016
Gastric cancer is one of the most lethal cancers worldwide despite many advances and options in therapy. As it is often diagnosed at an advanced stage, prognosis is poor with a median overall survival of less than twelve months. Chemotherapy remains the mainstay of treatment for these patients but it confers only a moderate survival advantage. There remains a need for new targeted treatment options and a way to better define patient populations who will benefit from these agents. In the past few years, there has been a better understanding of the biology, molecular profiling, and heterogeneity of gastric cancer. Our increased knowledge has led to the identification of gastric cancer subtypes and to the development of new targeted therapeutic agents. There are now two new targeted agents, trastuzumab and ramucirumab, that have recently been approved for the treatment of advanced and metastatic gastric cancer. There are also many other actively investigated targets, including epidermal growth factor receptor, the phosphatadylinositol 3-kinase/protein kinase B/mammalian target of rapamycin pathway, c-Met, poly ADP-ribose polymerase, and immune checkpoint inhibition. In this review, we discuss the current management of advanced gastric cancer as well as emerging targeted therapies and immunotherapy.
Core tip: Despite many advances in medical and surgical treatments, gastric cancer remains the second leading cause of cancer deaths. There is a greater understanding of the molecular heterogeneity of gastric cancer in recent years, resulting in the development and clinical investigation of different targeted agents. This review will discuss current treatment strategies and highlight targeted therapies and emerging drugs for advanced gastric cancer.