Hépato-Gastro & Oncologie Digestive


What is changing in practice for gastric cancer? Volume 26, issue 8, Octobre 2019

CHU Pontchaillou, Service des maladies de l’appareil digestif, 2 rue Henri Le Guilloux, 35033 Cedex 09 ; Université Rennes 1, Rennes
* Correspondance

Recently, the management of gastric cancers has undergone several notable changes. In the adjuvant setting, the FLOT (5-FU, oxaliplatin and docetaxel) perioperative tritherapy has replaced the standard 5-FU and platinum-salt-based bitherapy regimen, as it was shown more effective. This perioperative chemotherapy must also by administered in localized signet ring celle adenocarcinomas, which should not be operated immediately. Systematic measure of uracilemia to detect dihydropyrimidine dehydrogenase deficiency is now recommended before starting fluoropyrimidine-based chemotherapy. In metastatic setting, currently available data do not show interest in continuing anti-HER2 therapy beyond the second line for HER2-overexpressing tumors. In contrast, for all adenocarcinomas, trifluridine-tipiracil is the first drug showing efficacy in the third line and a marketing authorization application is ongoing in Europe. Immunotherapy remains under evaluation because its superiority over chemotherapy has not been demonstrated to date, except in case of microsatellite instability (MSI) that has been shown to be a predictive biomarker of sensitivity to immune checkpoint inhibitors. It is therefore important to seek MSI status in order to refer patients to immunotherapy trials.

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