Systemic therapy beyond first-line in advanced gastric cancer: An overview of the main randomized clinical trials

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8 Citations (Scopus)

Abstract

Following progression on first-line platinum and fluoropyrimidine-based chemotherapy, prognosis for advanced gastric cancer patients is extremely poor. Thus, new and effective treatments are required. Based on positive results of recent randomized controlled trials, second-line monochemotherapies with either irinotecan or taxanes confer a median overall survival of approximately 5 months in gastro-esophageal and gastric adenocarcinoma. Combination of weekly paclitaxel and ramucirumab, a novel anti-angiogenic VEGFR2 antibody, pushes the overall survival up to over 9.5 months, whereas apatinib, a novel oral VEGFR2 tyrosine kinase inhibitor, seems to be promising in heavily pretreated patients. In contrast, the role of EGFR/HER2 and mTOR inhibitors is controversial. Studies are heterogeneous for tumor population, geographical areas, quality of life assessment, type of first-line therapy and response to that, making clinical practice application of the trial results difficult. Furthermore, sustainability is challenging due to high cost of novel biotherapies.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalCritical Reviews in Oncology/Hematology
Volume99
DOIs
Publication statusPublished - Mar 1 2016

Fingerprint

irinotecan
Stomach Neoplasms
Randomized Controlled Trials
Taxoids
Biological Therapy
Survival
Paclitaxel
Platinum
Protein-Tyrosine Kinases
Stomach
Adenocarcinoma
Quality of Life
Costs and Cost Analysis
Drug Therapy
Antibodies
Therapeutics
Population
Neoplasms
apatinib
ramucirumab

Keywords

  • Advanced gastric cancer
  • Molecular targeted agents
  • Randomized controlled trials
  • Second-line chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Hematology
  • Geriatrics and Gerontology

Cite this

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title = "Systemic therapy beyond first-line in advanced gastric cancer: An overview of the main randomized clinical trials",
abstract = "Following progression on first-line platinum and fluoropyrimidine-based chemotherapy, prognosis for advanced gastric cancer patients is extremely poor. Thus, new and effective treatments are required. Based on positive results of recent randomized controlled trials, second-line monochemotherapies with either irinotecan or taxanes confer a median overall survival of approximately 5 months in gastro-esophageal and gastric adenocarcinoma. Combination of weekly paclitaxel and ramucirumab, a novel anti-angiogenic VEGFR2 antibody, pushes the overall survival up to over 9.5 months, whereas apatinib, a novel oral VEGFR2 tyrosine kinase inhibitor, seems to be promising in heavily pretreated patients. In contrast, the role of EGFR/HER2 and mTOR inhibitors is controversial. Studies are heterogeneous for tumor population, geographical areas, quality of life assessment, type of first-line therapy and response to that, making clinical practice application of the trial results difficult. Furthermore, sustainability is challenging due to high cost of novel biotherapies.",
keywords = "Advanced gastric cancer, Molecular targeted agents, Randomized controlled trials, Second-line chemotherapy",
author = "Salvatore Galdy and Cella, {Chiara Alessandra} and Francesca Spada and Sabina Murgioni and Frezza, {Anna Maria} and Ravenda, {Simona Paola} and Zampino, {Maria Giulia} and Nicola Fazio",
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AU - Galdy, Salvatore

AU - Cella, Chiara Alessandra

AU - Spada, Francesca

AU - Murgioni, Sabina

AU - Frezza, Anna Maria

AU - Ravenda, Simona Paola

AU - Zampino, Maria Giulia

AU - Fazio, Nicola

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N2 - Following progression on first-line platinum and fluoropyrimidine-based chemotherapy, prognosis for advanced gastric cancer patients is extremely poor. Thus, new and effective treatments are required. Based on positive results of recent randomized controlled trials, second-line monochemotherapies with either irinotecan or taxanes confer a median overall survival of approximately 5 months in gastro-esophageal and gastric adenocarcinoma. Combination of weekly paclitaxel and ramucirumab, a novel anti-angiogenic VEGFR2 antibody, pushes the overall survival up to over 9.5 months, whereas apatinib, a novel oral VEGFR2 tyrosine kinase inhibitor, seems to be promising in heavily pretreated patients. In contrast, the role of EGFR/HER2 and mTOR inhibitors is controversial. Studies are heterogeneous for tumor population, geographical areas, quality of life assessment, type of first-line therapy and response to that, making clinical practice application of the trial results difficult. Furthermore, sustainability is challenging due to high cost of novel biotherapies.

AB - Following progression on first-line platinum and fluoropyrimidine-based chemotherapy, prognosis for advanced gastric cancer patients is extremely poor. Thus, new and effective treatments are required. Based on positive results of recent randomized controlled trials, second-line monochemotherapies with either irinotecan or taxanes confer a median overall survival of approximately 5 months in gastro-esophageal and gastric adenocarcinoma. Combination of weekly paclitaxel and ramucirumab, a novel anti-angiogenic VEGFR2 antibody, pushes the overall survival up to over 9.5 months, whereas apatinib, a novel oral VEGFR2 tyrosine kinase inhibitor, seems to be promising in heavily pretreated patients. In contrast, the role of EGFR/HER2 and mTOR inhibitors is controversial. Studies are heterogeneous for tumor population, geographical areas, quality of life assessment, type of first-line therapy and response to that, making clinical practice application of the trial results difficult. Furthermore, sustainability is challenging due to high cost of novel biotherapies.

KW - Advanced gastric cancer

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