University Cancer Center Leipzig (UCCL), University Clinic Leipzig, University of Leipzig, Liebigstr. 20, 04301, Leipzig, Germany,
Gastric Cancer. 2014 Apr;17(2):213-25. doi: 10.1007/s10120-013-0297-z. Epub 2013 Sep 19.
The optimal medical treatment for advanced gastric cancer is currently the source of debate. Cytotoxic treatment has been shown to prolong survival and provide improved symptom control compared with best supportive care alone, but a global standard has not yet been defined. A literature research was undertaken. Results were evaluated by an international author team. The conclusions of this are presented in this paper. Combination chemotherapy with cisplatin and 5-fluorouracil was the preferred first-line chemotherapy, but oxaliplatin has shown equivalent efficacy to cisplatin. Oral fluoropyrimidines, especially S-1 and capecitabine, can substitute for 5-fluorouracil. Modern doublet regimens are preferred in the majority of patients on the basis of a balanced benefit-to-risk ratio. In selected fit and compliant patients, especially those with a high tumor burden or potential secondary resectability, a third drug may be added because triplet chemotherapy led to higher responses rates and enhanced efficacy. However, docetaxel also adds a significant increase in side effects. Monotherapy and early dose modifications should be considered in elderly and infirm patients. Beyond that, our understanding of gastric cancer tumor biology is increasing. In HER2-positive gastric cancer, the addition of the monoclononal anti-HER2 antibody trastuzumab to cisplatin and fluoropyrimidines has prolonged survival duration. Second-line chemotherapy with single agents has now become a proven treatment option. Alternatively, anti-angiogenic treatment with ramucirumab is on the horizon. In conclusion, combination chemotherapy is regarded as the global standard of care for the first-line treatment of advanced gastric cancer. Molecularly targeted treatments are being explored, preferably in combination with a backbone of chemotherapy doublets.
目前，对于晚期胃癌的最佳治疗方法仍存在争议。与单纯最佳支持治疗相比，细胞毒性治疗已被证明能延长生存期并改善症状控制，但尚未确定全球标准。进行了文献研究。由国际作者团队对结果进行了评估。本文介绍了这些结论。顺铂和 5-氟尿嘧啶联合化疗是首选的一线化疗方案，但奥沙利铂已显示出与顺铂等效的疗效。口服氟嘧啶类药物，特别是 S-1 和卡培他滨，可以替代 5-氟尿嘧啶。基于平衡的获益-风险比，大多数患者首选现代双联方案。在选择合适和依从性好的患者中，特别是那些肿瘤负荷高或潜在可二次切除的患者，可以添加第三种药物，因为三联化疗可提高缓解率并增强疗效。然而，多西紫杉醇也会显著增加副作用。在老年和体弱患者中应考虑单药治疗和早期剂量调整。除此之外，我们对胃癌肿瘤生物学的认识正在不断提高。在 HER2 阳性胃癌中，添加曲妥珠单抗单克隆抗 HER2 抗体到顺铂和氟嘧啶类药物中已延长了生存时间。二线单药化疗现已成为一种已证实的治疗选择。或者，雷莫芦单抗的抗血管生成治疗也即将面世。总之，联合化疗被认为是晚期胃癌一线治疗的全球标准治疗方法。正在探索分子靶向治疗，最好与化疗双联方案联合应用。
