Bilici Ahmet
Ahmet Bilici, Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Bagcilar, 34214 Istanbul, Turkey.
World J Gastroenterol. 2014 Apr 14;20(14):3905-15. doi: 10.3748/wjg.v20.i14.3905.
Despite advances in the treatment of gastric cancer, it remains the world's second highest cause of cancer death. As gastric cancer is often diagnosed at an advanced stage, systemic chemotherapy is the mainstay of treatment for these patients. However, no standard palliative chemotherapy regimen has been accepted for patients with metastatic gastric cancer. Palliative chemotherapy including fluoropyrimidine, platin compounds, docetaxel and epirubicin prolongs survival, and improves a high quality of life to a greater extent than best supportive care. The number of clinical investigations associated with targeted agents has recently increased. Agents targeting the epidermal growth factor receptor 1 and human epidermal growth factor receptor 2 (HER2) have been widely tested. Trastuzumab was the first target drug developed, and pivotal phase III trials showed improved survival when trastuzumab was integrated into cisplatin/fluoropyrimidine-based chemotherapy in patients with metastatic gastric cancer. Trastuzumab in combination with chemotherapy was thus approved to be a new standard of care for patients with HER2-positive advanced esophagogastric adenocarcinoma. Thus, the evaluation of HER2 status in all patients with metastatic gastroesophageal adenocarcinoma should be considered. Other agents targeting vascular endothelial growth factor, mammalian target of rapamycin, and other biological pathways have also been investigated in clinical trials, but showed little impact on the survival of patients. In this review, systemic chemotherapy and targeted therapies for metastatic gastric cancer in the first- and second-line setting are summarized in the light of recent advances.
尽管胃癌治疗取得了进展，但它仍是全球癌症死亡的第二大主要原因。由于胃癌往往在晚期才被诊断出来，全身化疗是这些患者的主要治疗方法。然而，对于转移性胃癌患者，尚无被认可的标准姑息化疗方案。包括氟尿嘧啶、铂类化合物、多西他赛和表柔比星在内的姑息化疗可延长生存期，并且在提高生活质量方面比最佳支持治疗有更大程度的改善。近年来，与靶向药物相关的临床研究数量有所增加。针对表皮生长因子受体1和人表皮生长因子受体2（HER2）的药物已得到广泛测试。曲妥珠单抗是首个研发出的靶向药物，关键的III期试验表明，在转移性胃癌患者中，将曲妥珠单抗纳入基于顺铂/氟尿嘧啶的化疗方案可提高生存率。因此，曲妥珠单抗联合化疗被批准成为HER2阳性晚期食管胃腺癌患者的新治疗标准。因此，应考虑对所有转移性食管胃腺癌患者进行HER2状态评估。其他针对血管内皮生长因子、雷帕霉素靶蛋白及其他生物学途径的药物也已在临床试验中进行了研究，但对患者生存率的影响甚微。在本综述中，将根据最新进展总结一线和二线转移性胃癌的全身化疗及靶向治疗。
