Cancer Chemotherapy Center, Osaka Medical College, 2-7 Daigaku-Cho, Takatsuki, Osaka, 569-8686, Japan.
Gastric Cancer. 2011 Aug;14(3):206-11. doi: 10.1007/s10120-011-0072-y. Epub 2011 Jul 23.
Chemotherapy for gastric cancer has been advancing fairly well. It has been indicated that not only advances in first-line chemotherapy but also those in second-line chemotherapy have contributed to the prolongation of overall survival. The Arbeitsgemeinschaft Internistische Onkologie (AIO) study supports the idea that second-line chemotherapy is appropriate in patients with a good general condition. Also, the Japan Clinical Oncology Group (JCOG) integral analysis suggests that advances have been made in second-line chemotherapy. However, most recently reported studies of second-line chemotherapy have been conducted as small-scale phase II or retrospective trials. No randomized control trial to establish standard treatment has been reported. Which regimen is the most appropriate as second-line therapy must be investigated in the future. Currently, molecularly targeted agents for gastric cancer are being developed and tested in global trials. As a new issue in global trials, second-line chemotherapy has been emphasized. In recent global trials, subset analysis showed regional differences in overall survival. This was possibly associated with the regional differences in second-line chemotherapy. When developing new molecularly targeted agents for first-line chemotherapy, we cannot ignore the result that the proportion of patients in whom treatment was switched to second-line chemotherapy was high in Asia. In planning a global trial, this new issue should be sufficiently discussed.
胃癌的化疗进展相当顺利。研究表明，不仅一线化疗的进展，二线化疗的进展也延长了总生存期。德国肿瘤内科学会（AIO）的研究支持这样一种观点，即对于一般状况良好的患者，二线化疗是合适的。此外，日本肿瘤临床研究组（JCOG）的综合分析表明，二线化疗取得了进展。然而，最近报道的二线化疗研究大多是小规模的 II 期或回顾性试验。没有报道随机对照试验来确立标准治疗。哪种方案作为二线治疗最合适，这必须在未来进行研究。目前，针对胃癌的分子靶向药物正在进行全球临床试验。作为全球试验中的一个新问题，二线化疗受到了重视。在最近的全球试验中，亚组分析显示总生存的区域差异。这可能与二线化疗的区域差异有关。在开发用于一线化疗的新型分子靶向药物时，我们不能忽视亚洲患者接受二线化疗的比例较高的结果。在规划全球试验时，应充分讨论这一新问题。
