Advanced gastric cancer: Current treatment landscape and future perspectives
Advanced gastric cancer: Current treatment landscape and future perspectives
复制标题
DOI：
10.3748/wjg.v22.i8.2403
复制
发表时间：
2016-02-28
影响因子：
4.3
通讯作者：
Wagner, Anna Dorothea
中科院分区：
文献类型：
--
作者：
Digklia, Antonia;Wagner, Anna Dorothea
目前，胃癌在全球癌症相关死亡率中排名第四。在西方世界，最常见的诊断是在晚期，在远处转移后。晚期(局部晚期或转移性)患者预后较差，中位总生存期为10~12个月，姑息化疗是治疗的主要手段。近年来，使用抑制人表皮生长因子受体2(HER2)的新方法在HER2过度表达患者的一线治疗中，与单纯化疗相比，在无进展和总生存期方面有显著改善。此外，在随机研究中，与最佳支持性治疗相比，二线化疗和血管内皮生长因子受体抑制剂Ramucirumab治疗在总存活率方面都显示出显著的好处。此外，在转移性胃癌患者的二线治疗中，Ramucirumab联合化疗在无进展和总存活率方面显示出比单独化疗更显著的好处。最近公布的胃癌分子分类有望改善临床试验的患者分层和选择，并为未来的药物开发提供路线图。然而，尽管有这些进展，进展期胃癌患者的预后仍然很差。在这篇综述中，我们讨论了目前的护理标准，并概述了胃癌药物开发的主要主题。
Gastric cancer currently ranks fourth in cancer-related mortality worldwide. In the western world, it is most often diagnosed at an advanced stage, after becoming metastatic at distant sites. Patients with advanced disease (locally advanced or metastatic) have a somber prognosis, with a median overall survival of 10-12 mo, and palliative chemotherapy is the mainstay of treatment. In recent years, novel approaches using inhibition of human epidermal growth factor receptor 2 (HER2) have demonstrated significant improvements in progression-free and overall survival, compared with chemotherapy alone, in first-line treatment of patients with overexpression of HER2. In addition, both second-line chemotherapy and treatment with the vascular endothelial growth factor receptor-inhibitor ramucirumab demonstrated significant benefits in terms of overall survival, compared with best supportive care, in randomized studies. Moreover, ramucirumab in combination with chemotherapy demonstrated further significant benefits in terms of progression-free and overall survival, compared with chemotherapy alone, in second-line treatment for patients with metastatic gastric cancer. A recently published molecular classification of gastric cancer is expected to improve patient stratification and selection for clinical trials and provide a roadmap for future drug development. Nevertheless, despite these developments the prognosis of patients with advanced gastric cancer remains poor. In this review we discuss current standards of care and outline major topics of drug development in gastric cancer.