Centre Léon Bérard, département de cancérologie médicale, 28 rue Laennec, 69373 Lyon cedex 08, France
In recent years, the treatment of advanced gastric cancer has greatly evolved due to the large use of treatments in the second- and third-line settings. Thus, a significant number of patients are candidates for a 2nd line treatment. In Europe, only 15 to 45% of patients are treated after failure of first-line chemotherapy as opposed to 75% in Asia. Second-line chemotherapy can be based on taxanes (docetaxel or paclitaxel) or irinotecan but do not include antiHER2 treatment in HER2 overexpressing tumors. The use of ramucirumab in 2nd line in combination with paclitaxel is also an option, now hampered in France due to uncertainties about its reimbursement. Finally, another antiangiogenic (apatinib) showed very promising results in Asian patients after failure of two or more chemotherapy regimens. At last, immunotherapy and especially immune checkpoint inhibitors have been tested in gastric cancer and showed early interesting results.