Mizrak Kaya Dilsa, Harada Kazuto, Shimodaira Yusuke, Amlashi Fatemeh G, Lin Quan, Ajani Jaffer A
a Department of Gastrointestinal Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
Expert Rev Clin Pharmacol. 2017 Mar;10(3):263-271. doi: 10.1080/17512433.2017.1279969. Epub 2017 Feb 3.
Gastric adenocarcinoma (GAC) is the fifth most common cancer and third leading cause of cancer related mortality worldwide. When localized, cure is achievable with surgery and adjunctive therapies in some patients, however, once advanced, GAC is not a curable condition. Only two targeted agents (trastuzumab and ramucirumab) have been approved and apatinib was approved only in China. Because of the heterogeneous nature of GAC, it is not possible to assess a standard therapeutic approach. Areas covered: In this review, we aimed to describe the optimal systemic therapy regimens for advanced GAC. A literature search was performed to identify all phase II-III studies about advanced GAC from PubMed, clinicaltrials.gov, American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) websites. Expert commentary: A combination of a platinum compound and a fluoropyrimidine is ideal as first line therapy. Trastuzumab should be added if the tumor is HER2 positive. In the second line setting, paclitaxel/ramucirumab is preferred over ramucirumab alone. Recently, two similar molecular classifications for GAC have been proposed. A better understanding of molecular and immune biology of GAC could identify new therapeutic targets.
胃腺癌（GAC）是全球第五大常见癌症，也是癌症相关死亡的第三大主要原因。在疾病局限时，部分患者通过手术及辅助治疗可实现治愈，但一旦病情进展，GAC则无法治愈。目前仅有两种靶向药物（曲妥珠单抗和雷莫西尤单抗）获批，而阿帕替尼仅在中国获批。由于GAC具有异质性，因此无法评估标准的治疗方法。涵盖领域：在本综述中，我们旨在描述晚期GAC的最佳全身治疗方案。通过文献检索，从PubMed、clinicaltrials.gov、美国临床肿瘤学会（ASCO）和欧洲医学肿瘤学会（ESMO）网站上识别所有关于晚期GAC的II-III期研究。专家评论：铂类化合物与氟嘧啶联合作为一线治疗较为理想。如果肿瘤为HER2阳性，则应加用曲妥珠单抗。在二线治疗中，紫杉醇/雷莫西尤单抗优于单独使用雷莫西尤单抗。最近，有人提出了两种类似的GAC分子分类方法。更好地了解GAC的分子和免疫生物学特性可能会发现新的治疗靶点。
