title: Medical management of gastric cancer: a 2014 update.
abstract: Gastric cancer represents a serious health problem on a global scale. It is the second leading cause of cancer-related death worldwide. Novel therapeutic targets are desperately needed because the meager improvement in the cure rate of about 10% realized by adjunctive treatments to surgery is unacceptable as > 50% patients with localized gastric cancer succumb to their disease. Either postoperative chemoradiotherapy (United States), pre-and post-operative chemotherapy (Europe), and adjuvant chemotherapy after a D2 resection (Asia) can all be regarded as standards of care in the localized gastric cancer management. In metastatic disease the addition of trastuzumab to chemotherapy is standard of care in Her2 positive disease. In the HER2 negative population, the treatments remain limited. In the first line setting, the standard of care is a combination of fluoropyrimidine and platinum containing chemotherapy, with or without epirubicin or docetaxel. The results of targeted therapy trials have by and large been disappointing, but none of these trials looked at an appropriately enriched population. Finally there is a meager overall survival benefit in treating patients with metastatic disease in the second line setting, with either irinotecan, docetaxel or ramucirumab however none of these drugs have been compared head to head in a well-powered randomized controlled trial.
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Elena
authors.initials: E
authors.lastname: Elimova
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Hironori
authors.initials: H
authors.lastname: Shiozaki
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Roopma
authors.initials: R
authors.lastname: Wadhwa
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sudo
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Qiongrong
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Jeannelyn S
authors.initials: JS
authors.lastname: Estrella
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Badgwell
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Shumei
authors.initials: S
authors.lastname: Song
authors.affiliation: Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Kazuki Sudo, Qiongrong Chen, Mariela A Blum, Shumei Song, Jaffer A Ajani, Department of Gastrointestinal Medical Oncology, University of Texas, Anderson Cancer Center, Houston, TX 77030, United States.
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D006801:Humans; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Chemoradiation; Chemotherapy; Gastric cancer; Localized; Metastatic