Digklia Antonia, Wagner Anna Dorothea
Antonia Digklia, Anna Dorothea Wagner, Departement d'Oncologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
World J Gastroenterol. 2016 Feb 28;22(8):2403-14. doi: 10.3748/wjg.v22.i8.2403.
Gastric cancer currently ranks fourth in cancer-related mortality worldwide. In the western world, it is most often diagnosed at an advanced stage, after becoming metastatic at distant sites. Patients with advanced disease (locally advanced or metastatic) have a somber prognosis, with a median overall survival of 10-12 mo, and palliative chemotherapy is the mainstay of treatment. In recent years, novel approaches using inhibition of human epidermal growth factor receptor 2 (HER2) have demonstrated significant improvements in progression-free and overall survival, compared with chemotherapy alone, in first-line treatment of patients with overexpression of HER2. In addition, both second-line chemotherapy and treatment with the vascular endothelial growth factor receptor-inhibitor ramucirumab demonstrated significant benefits in terms of overall survival, compared with best supportive care, in randomized studies. Moreover, ramucirumab in combination with chemotherapy demonstrated further significant benefits in terms of progression-free and overall survival, compared with chemotherapy alone, in second-line treatment for patients with metastatic gastric cancer. A recently published molecular classification of gastric cancer is expected to improve patient stratification and selection for clinical trials and provide a roadmap for future drug development. Nevertheless, despite these developments the prognosis of patients with advanced gastric cancer remains poor. In this review we discuss current standards of care and outline major topics of drug development in gastric cancer.
目前，胃癌在全球癌症相关死亡率中排名第四。在西方世界，胃癌大多在晚期被诊断出来，此时癌症已转移至远处。晚期疾病（局部晚期或转移性）患者的预后不佳，中位总生存期为10 - 12个月，姑息化疗是主要治疗手段。近年来，在一线治疗中，对于人表皮生长因子受体2（HER2）过表达的患者，采用抑制HER2的新方法与单纯化疗相比，在无进展生存期和总生存期方面均有显著改善。此外，在随机研究中，二线化疗以及使用血管内皮生长因子受体抑制剂雷莫西尤单抗治疗与最佳支持治疗相比，在总生存期方面均显示出显著益处。而且，对于转移性胃癌患者的二线治疗，与单纯化疗相比，雷莫西尤单抗联合化疗在无进展生存期和总生存期方面进一步显示出显著益处。最近发表的胃癌分子分类有望改善患者分层和临床试验的选择，并为未来药物研发提供路线图。尽管如此，尽管有这些进展，晚期胃癌患者的预后仍然很差。在本综述中，我们讨论了当前的治疗标准，并概述了胃癌药物研发的主要课题。
