title: Second-line treatment of metastatic gastric cancer: Current options and future directions.
abstract: Gastric cancer remains one among the leading causes of cancer-related deaths, regardless of its decreasing incidence and newly available treatment options. Most patients present at an advanced stage and are treated with upfront systemic chemotherapy. Those patients receiving first-line therapy may initially respond to treatment, but many of them relapse over time. In such condition, second-line treatment for disease progression remains the only available option. Although there exists no standard approach in the second-line setting, several phase III trials have shown modest survival benefit in patients receiving irinotecan, taxane and ramucirumab over the best supportive care or active agents. This review analyzes the currently available treatment regimens and future directions of research in the second-line setting for metastatic gastric cancer with the best available evidence. Additionally, the prognostic factors that influence patient survival in those receiving second-line therapy are discussed.
authors.affiliation: Dheepak Kanagavel, Mikhail Fedyanin, Alexey Tryakin, Sergei Tjulandin, Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia.
authors.forename: Dheepak
authors.initials: D
authors.lastname: Kanagavel
authors.affiliation: Dheepak Kanagavel, Mikhail Fedyanin, Alexey Tryakin, Sergei Tjulandin, Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Fedyanin
authors.affiliation: Dheepak Kanagavel, Mikhail Fedyanin, Alexey Tryakin, Sergei Tjulandin, Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia.
authors.forename: Alexey
authors.initials: A
authors.lastname: Tryakin
authors.affiliation: Dheepak Kanagavel, Mikhail Fedyanin, Alexey Tryakin, Sergei Tjulandin, Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia.
authors.forename: Sergei
authors.initials: S
authors.lastname: Tjulandin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000235:genetics; D006801:Humans; D009362:Neoplasm Metastasis; D057285:Precision Medicine; D019233:Retreatment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Irinotecan; Metastatic gastric cancer; Ramucirumab; Second-line chemotherapy; Targeted therapy; Taxane