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

Salvatore Galdy, Chiara Alessandra Cella, Francesca Spada, Sabina Murgioni, Anna Maria Frezza, Simona Paola Ravenda, Maria Giulia Zampino, Nicola Fazio

Research output: Contribution to journalArticlepeer-review


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
Publication statusPublished - Mar 1 2016


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

ASJC Scopus subject areas

  • Oncology
  • Hematology
  • Geriatrics and Gerontology


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