Current treatment and recent progress in gastric cancer
Current treatment and recent progress in gastric cancer
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DOI：
10.3322/caac.21657
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发表时间：
2021-02-16
影响因子：
254.7
通讯作者：
Badgwell, Brian D.
中科院分区：
文献类型：
--
作者：
Joshi, Smita S.;Badgwell, Brian D.
胃癌不是美国的十大恶性肿瘤，但却是全球癌症死亡的最常见原因之一。来自东方和西方国家的肿瘤之间的生物学差异增加了基于国际试验确定标准治疗的复杂性。全身化疗、放疗、手术、免疫治疗和靶向治疗在胃腺癌中均已证实有效;因此，多学科治疗对治疗选择至关重要。可切除胃癌的三联化疗现已被接受，并可代表局部疾病的标准细胞毒性化疗的平台期。基于分子亚型的胃癌分类为个性化治疗提供了机会。生物标志物，特别是微卫星不稳定性（MSI），程序性细胞死亡配体1（PD-L1），人表皮生长因子受体2（HER 2），肿瘤突变负荷和EB病毒，正在越来越多地推动系统治疗方法，并允许识别最有可能从免疫治疗和靶向治疗中受益的人群。对于分化程度较低的胃腺癌组织学亚型和没有免疫治疗活性标志物的胃腺癌，仍有重要的研究机会。
Gastric cancer is not a top-10 malignancy in the United States but represents one of the most common causes of cancer death worldwide. Biological differences between tumors from Eastern and Western countries add to the complexity of identifying standard-of-care therapy based on international trials. Systemic chemotherapy, radiotherapy, surgery, immunotherapy, and targeted therapy all have proven efficacy in gastric adenocarcinoma; therefore, multidisciplinary treatment is paramount to treatment selection. Triplet chemotherapy for resectable gastric cancer is now accepted and could represent a plateau of standard cytotoxic chemotherapy for localized disease. Classification of gastric cancer based on molecular subtypes is providing an opportunity for personalized therapy. Biomarkers, in particular microsatellite instability (MSI), programmed cell death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (HER2), tumor mutation burden, and Epstein-Barr virus, are increasingly driving systemic therapy approaches and allowing for the identification of populations most likely to benefit from immunotherapy and targeted therapy. Significant research opportunities remain for the less differentiated histologic subtypes of gastric adenocarcinoma and those without markers of immunotherapy activity.