Management of advanced gastric cancer. Current status and future therapeutic strategies

In the metastatic setting treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can help to maintain a better quality of life. The aim of this study was to discuss the new treatment options and the existing results in advanced gastric cancer. Treatment recommendations are given in consideration of updated literature (Pubmed, MEDLINE and manual search). Combination chemotherapy including a platinum compound and a fluoropyrimidine are regarded as the gold standard of care. Oxaliplatin can substitute for cisplatin while capecitabine or S1 can substitute for infusional 5-FU. In elderly patients oxaliplatin has advantages compared with cisplatin. Triplet combinations containing a platinum salt, a fluoropyrimidine and a taxane or (with less evidence) an anthracycline are more efficacious but also expose patients to more side effects. Second line chemotherapy is indicated for patients who progress during or after first line chemotherapy. The monoclonal antibody trastuzumab has been shown to prolong survival when combined with cisplatin and 5-FU or capecitabine in gastric cancer patients with overexpression of the growth factor HER2. The therapeutic options for advanced gastric cancer have significantly increased. Presently, there are several effective treatment regimens available.