News in the adenocarcinoma of oesophagus and gastric adenocarcinoma treatment – present and future

02/2017

MUDr. Radka Obermannová, Ph.D.

Klinika komplexní onkologické péče, Masarykův onkologický ústav, Brno

SUMMARY

Adenocarcinoma of distal oesophagus and gastric adenocarcinoma still have a poor clinical outcome. In locally advanced adenocarcinoma multimodal treatment has reached maximum of median overall survival. New molecular predictors defined recently by The Cancer Genome Atlas offer an opportunity of patient stratification to optimal treatment approach. PET/CT is a valuable method providing earlier identification of non-responders and enabling a well-timed change of ineffective treatment. Metastatic gastric cancer is very heterogeneous disease. Trastuzumab is the only clinically valid targeted therapy with a known molecular predictor. Antiangiogenic treatment is a standard of care in the second line treatment. Despite promising phase I/II clinical trials results, several phase III studies assessing receptor tyrosine kinase-related signaling pathways such as epidermal growth factor receptor, hepatocyte growth factor receptor (MET/HGF) or mammalian target of rapamycine receptor (mTOR) failed. Novel treatment targets include activation of immune response by PD-1/PD-L1 checkpoint inhibitors, inhibition of cancer stemness-related signaling pathways like STAT3, targeting DNA damage repair, stroma modification by matrix metalloproteinase-9 inhibition and Claudin-18.2, a tight junction protein antibody.

KEY WORDS

oesophagus adenocarcinoma, gastric cancer, locally advanced disease, metastatic disease, targeted treatment