Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.303
Peer-review started: May 15, 2015
First decision: July 1, 2015
Revised: July 15, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: November 15, 2015
Gastric cancer is the third leading cause of cancer death worldwide. Even though during these last decades gastric cancer incidence decreased in Western countries, it remains endemic and with a high incidence in Eastern countries. The survival in advanced and metastatic stage of gastric cancer is still very poor. Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients. Indeed, the key point is still the selection of patients for the right treatment, on basis of molecular tumor characterization. Since chemotherapy reached a plateau of efficacy for gastric cancer, the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity. Currently, Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erbB2 positive patients, whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer. New perspectives for an effective treatment derived from the immunotherapeutic strategies. Here, we report an overview on gastric cancer treatments, with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.
Core tip: Gastric cancer, despite its decrease in West Countries, remains one of the most common malignancies worldwide. The prognosis in the advanced setting is often poor even with a multidisciplinary approach, which aims to increase the patients’ survival. The molecular classification of four subtypes of gastric adenocarcinomas (The Cancer Genome Atlas project) allowed a better stratification of patients in clinical trials for targeted therapies. Biologic agents, modulating the immune checkpoints, seem to be the best promising therapeutic approach, opening new perspective for advanced gastric cancer treatment.