title: Recent insights in the therapeutic management of patients with gastric cancer.
abstract: Gastric cancer remains frequent and one of the most lethal malignancies worldwide. In this article, we aimed to comprehensively review recent insights in the therapeutic management of gastric cancer, with focus on the surgical and perioperative management of resectable forms, and the latest advances regarding advanced diseases. Surgical improvements comprise the use of laparoscopic surgery including staging laparoscopy, a better definition of nodal dissection, and the development of hyperthermic intraperitoneal chemotherapy. The best individualized perioperative management should be assessed before curative-intent surgery for all patients and can consists in perioperative chemotherapy, adjuvant chemo-radiation therapy or adjuvant chemotherapy alone. The optimal timing and sequence of chemotherapy and radiation therapy with respect to surgery should be further explored. Patients with advanced gastric cancer have a poor prognosis. Nevertheless, they can benefit from doublet or triplet chemotherapy combination, including trastuzumab in HER2-positive patients. Upon progression, second-line therapy can be considered in patients with good performance status. Although anti-HER2 (trastuzumab) and anti-VEGFR (ramucirumab) may yield survival benefit, anti-EGFR and anti-HGFR therapies have failed to improve outcomes. Nevertheless, combination regimens containing cytotoxic drugs and targeted therapies should be further evaluated; keeping in mind that gastric cancer biology is different between Asia and the Western countries.
authors.affiliation: Service d'Hépato-Gastroentérologie et de Cancérologie Digestive, CHU Robert Debré, Reims, France.
authors.forename: Louis
authors.initials: L
authors.lastname: de Mestier
authors.affiliation: Service de Chirurgie Générale, Digestive et Endocrinienne, CHU Robert Debré, Reims, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lardière-Deguelte
authors.affiliation: Service d'Hépato-Gastroentérologie et de Cancérologie Digestive, CHU Robert Debré, Reims, France; Unité de Médecine Ambulatoire - Cancérologie-Hématologie, CHU Robert Debré, Reims, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Volet
authors.affiliation: Service de Chirurgie Générale, Digestive et Endocrinienne, CHU Robert Debré, Reims, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Service d'Hépato-Gastroentérologie et de Cancérologie Digestive, CHU Robert Debré, Reims, France; Unité de Médecine Ambulatoire - Cancérologie-Hématologie, CHU Robert Debré, Reims, France. Electronic address: obouche@chu-reims.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouché
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D010535:Laparoscopy; D058990:Molecular Targeted Therapy; D011878:Radiotherapy; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D000068878:Trastuzumab / Q000627:therapeutic use; D000096662:Ramucirumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068878:Trastuzumab; D000096662:Ramucirumab
keywords: Chemotherapy; Gastric neoplasms; Peritoneal carcinomatosis; Prognosis; Radiation therapy; Surgery; Target therapy