News in systemic treatment of metastatic gastric cancer and gastroesophageal junction cancer

03/2020

Doc. MUDr. David Vrána, Ph.D.

Komplexní onkologické centrum, Nemocnice Nový Jičín

SUMMARY

The goals of the treatment of the gastric and gastroesophageal junction adenocarcinoma is the quality of life, symptoms palliation and improvement in the overall survival. The generally recommended regimen in the first line setting is the chemotherapy combination based on platinum derivates (cisplatin or oxaliplatin) eventually with trastuzumab in tumors with HER2 overexpression. Nowadays, pembrolizumab is also the treatment of choice in the first line. The standard regimen in the second and later lines is much less defined. For patients in good performance status paclitaxel with ramucirumab remains generally recommended treatment of choice eventually monotherapy with taxane, irinotecan or capecitabine. In patients with MSI-H (microsatellite instability-high) or dMMR (deficient mismatch repair) tumors pembrolizumab is the treatment of choice. In third line of the treatment trifluridine/tipiracil is the new treatment standard. The aim of this article is to summarize the current treatment strategy of the locally advanced or metastatic gastric and gastroesophageal junction adenocarcinoma.

Key words

metastatic gastric cancer and gastroesophageal junction cancer, paclitaxel, ramucirumab, trifluridine/tipiracil, pembrolizumab, nivolumab