Hépato-Gastro & Oncologie Digestive


Systemic therapy for metastatic gastric adenocarcinoma: which strategy? Volume 20, issue 6, Juin 2013

CHU de Nantes, Institut des maladies de l’appareil digestif, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France

Metastatic gastric adenocarcinoma remains an aggressive disease with a poor prognosis, despite recent progresses. Treatment aims at prolonging the life and improving its quality. Many chemotherapy regimens are available. Three-drug docetaxel- or epirubicin-based chemotherapy regimens are superior to two-drug therapies, but are also more toxic. The choice of chemotherapy should be guided by the patient's condition and comorbidities, and by the expected adverse effects. In this setting, bevacizumab and anti-EGFR (Epidermal Growth Factor Receptor) failed to improve patients’ survival. The addition of trastuzumab to a two-drug chemotherapy regimen can improve overall survival, but the treatment is limited to patients with HER-2-expressing tumors. In first line therapy, promising results have been recently reported with rilotumumab, an anti-HGF (Hepatocyte Growth Factor) antibody, but they must be confirmed in phase III trials. Recent studies have demonstrated the survival benefits of both second line chemotherapy and ramucirumab, an anti-Vascular Endothelium Growth Factor receptor type 2. A personalized therapy, based on clinical and biological parameters should improve the patients’ outcomes.