title: Advanced gastric cancer: Current treatment landscape and future perspectives.
abstract: Gastric cancer currently ranks fourth in cancer-related mortality worldwide. In the western world, it is most often diagnosed at an advanced stage, after becoming metastatic at distant sites. Patients with advanced disease (locally advanced or metastatic) have a somber prognosis, with a median overall survival of 10-12 mo, and palliative chemotherapy is the mainstay of treatment. In recent years, novel approaches using inhibition of human epidermal growth factor receptor 2 (HER2) have demonstrated significant improvements in progression-free and overall survival, compared with chemotherapy alone, in first-line treatment of patients with overexpression of HER2. In addition, both second-line chemotherapy and treatment with the vascular endothelial growth factor receptor-inhibitor ramucirumab demonstrated significant benefits in terms of overall survival, compared with best supportive care, in randomized studies. Moreover, ramucirumab in combination with chemotherapy demonstrated further significant benefits in terms of progression-free and overall survival, compared with chemotherapy alone, in second-line treatment for patients with metastatic gastric cancer. A recently published molecular classification of gastric cancer is expected to improve patient stratification and selection for clinical trials and provide a roadmap for future drug development. Nevertheless, despite these developments the prognosis of patients with advanced gastric cancer remains poor. In this review we discuss current standards of care and outline major topics of drug development in gastric cancer.
authors.affiliation: Antonia Digklia, Anna Dorothea Wagner, Departement d'Oncologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
authors.forename: Antonia
authors.initials: A
authors.lastname: Digklia
authors.affiliation: Antonia Digklia, Anna Dorothea Wagner, Departement d'Oncologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
authors.forename: Anna Dorothea
authors.initials: AD
authors.lastname: Wagner
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D055808:Drug Discovery; D020022:Genetic Predisposition to Disease; D006801:Humans; D025202:Molecular Diagnostic Techniques; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D010641:Phenotype; D057285:Precision Medicine; D011237:Predictive Value of Tests; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chemotherapy; Clinical trials; Gastric cancer; Perspectives; Phase III; Targeted therapy