Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.263
Peer-review started: June 20, 2015
First decision: July 27, 2015
Revised: August 14, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: November 15, 2015
Gastric cancer (GC) is a common lethal malignancy. Gastroesophageal junction and gastric cardia tumors are the fastest rising malignancies due to increasing prevalence of obesity and acid reflex in the United States. Traditional chemotherapy remains the main treatment with trastuzumab targeting human epidermal growth factor receptor 2 positive disease. The median overall survival (OS) is less than one year for advanced GC patients; thus, there is an urgent unmet need to develop novel therapy for GC. Although multiple targeted agents were studied, only the vascular endothelial growth factor receptor inhibitor ramucirumab was approved recently by the United States Food and Drug Administration because of its 1.4 mo OS benefit (5.2 mo vs 3.8 mo, P = 0.047) as a single agent; 2.2 mo improvement of survival (9.6 mo vs 7.4 mo, P = 0.017) when combined with paclitaxel in previously treated advanced GC patients. It is the first single agent approved for previously treated GC and the second biologic agent after trastuzumab. Even with limited success, targeted therapy may be improved by developing new biomarkers. Immune therapy is changing the paradigm of cancer treatment and is presently under active investigation for GC in clinical trials. More evidence supports GC stem cells existence and early stage studies are looking for its potential therapeutic possibilities.
Core tip: Advanced gastric cancer (GC) has very poor outcome with chemotherapy remains the main treatment. There is an urgent unmet need to develop novel therapy for GC. Limited success is achieved for targeted therapy after trastuzumab for human epidermal growth factor receptor 2 positive disease. Ramucirumab was recently approved by Food and Drug Administration as a single agent or combined with paclitaxel in refractory advanced GC patients. Immune therapy and GC stem cell research are on the horizon.