title: Metastatic gastric cancer treatment: Second line and beyond.
abstract: Advanced gastric cancer (aGC), not amenable to curative surgery, is still a burdensome illness tormenting afflicted patients and their healthcare providers. Whereas combination chemotherapy has been shown to improve survival and tumor related symptoms in the frontline setting, second-line therapy (SLT) is subject to much debate in the scientific community, mainly because of the debilitating effects of GC, which would impede the administration of cytotoxic therapy. Recent data has provided sufficient evidence for the safe use of SLT in patients with an adequate performance status. Taxanes, Irinotecan and even some Fluoropyrimidine analogs were found to provide a survival advantage in this subset of patients. Most importantly, quality of life measures were also improved through the use of adequate therapy. Even more pertinent were the findings involving antiangiogenic agents, which would add measurable improvements without significantly jeopardizing the patients' well-being. Further lines of therapy are cause for much more debate nowadays, but specific targeted agents have shown considerable promise in this context. We herein review noteworthy published data involving the use of additional lines of the therapy after failure of standard frontline therapies in patients with aGC.
authors.affiliation: Marwan Ghosn, Hampig Raphael Kourie, Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon.
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghosn
authors.affiliation: Marwan Ghosn, Hampig Raphael Kourie, Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon.
authors.forename: Samer
authors.initials: S
authors.lastname: Tabchi
authors.affiliation: Marwan Ghosn, Hampig Raphael Kourie, Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon.
authors.forename: Hampig Raphael
authors.initials: HR
authors.lastname: Kourie
authors.affiliation: Marwan Ghosn, Hampig Raphael Kourie, Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Tehfe
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors
keywords: Advanced gastric cancer; Cytotoxic; Second-line; Targeted therapy; Treatment