Chemotherapy Strategies in Gastric Cancer Treatment
Summary
Gastric cancer remains a major cause of cancer mortality worldwide, with significant geographic variation in incidence and treatment practice. Chemotherapy forms a cornerstone of management at multiple stages of the disease pathway, from perioperative and adjuvant settings in resectable tumours to first- and second-line approaches in advanced or metastatic disease. Standard frontline regimens typically combine a platinum agent (cisplatin or oxaliplatin) with a fluoropyrimidine (5-fluorouracil or capecitabine), often augmented by an anthracycline or a taxane in triplet protocols. Perioperative chemotherapy has demonstrated survival gains by downstaging tumours and improving resection rates, while adjuvant chemotherapy following D2 lymphadenectomy reduces recurrence risk. In the metastatic setting, doublet platinum-fluoropyrimidine combinations remain standard, with taxanes or irinotecan introduced on progression. Tailoring of dose intensity and sequence is increasingly important to balance efficacy with toxicity, particularly in older or frail patients. Emerging strategies include liposomal drug delivery to enhance tumour uptake and minimise systemic exposure, alongside molecular profiling to guide patient selection and combination with targeted agents. Overall, chemotherapy in gastric cancer continues to evolve through optimisation of agents, schedules and supportive measures to extend survival and maintain quality of life.
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Chemotherapy Strategies in Gastric Cancer Treatment publication trend
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Technical terms
Neutropenia: abnormally low concentration of neutrophils in peripheral blood, predisposing to infection.
Progression-free survival (PFS): interval from treatment initiation to disease progression or death from any cause.
Overall survival (OS): duration from treatment start until death from any cause, reflecting ultimate clinical benefit.
Objective response rate (ORR): proportion of patients achieving a predefined reduction in tumour size on imaging.
References
- Phase 1 Study of the Liposomal Formulation of Eribulin (E7389-LF): Results From the Advanced Gastric Cancer Expansion Cohort. Clinical Cancer Research (2023).
- Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. The Lancet Oncology (2013).
- Efficacy of Reduced-Intensity Chemotherapy With Oxaliplatin and Capecitabine on Quality of Life and Cancer Control Among Older and Frail Patients With Advanced Gastroesophageal Cancer. JAMA Oncology (2021).
- Optimal first-line chemotherapeutic treatment in patients with locally advanced or metastatic esophagogastric carcinoma: triplet versus doublet chemotherapy: a systematic literature review and meta-analysis. Cancer and Metastasis Reviews (2015).
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