Ilson David H
Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical College, New York, USA.
Curr Opin Gastroenterol. 2017 Nov;33(6):473-476. doi: 10.1097/MOG.0000000000000395.
To review recent studies in esophagogastric cancer.
Positive emission tomography (PET) scan in follow-up after curative treatment of esophagogastric cancer did not lead to improved survival. In the preoperative treatment of esophagogastric cancer, the addition of the antivascular endothelial growth factor agent bevacizumab to perioperative chemotherapy with combination epirubicin, cisplatinum, and 5-fluorouracil (5-FU; ECF) failed to improve survival compared with chemotherapy alone. In a head-to-head comparison of preoperative chemotherapy for locally advanced gastric and esophagogastric adenocarcinoma, FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) significantly improved overall survival compared with ECF. Assessing response to induction chemotherapy prior to combined preoperative chemoradiotherapy in PET nonresponding patients allowed a change in chemotherapy during subsequent radiotherapy with improved rates of pathologic complete response. In human epidermal growth factor receptor-2-positive advanced esophagogastric adenocarcinoma, second-line treatment with the chemotherapy/trastuzumab drug conjugate emtansine/trastuzumab failed to improve response or overall survival compared with treatment using paclitaxel chemotherapy. The immune checkpoint inhibitor, nivolumab, improved survival in refractory gastric cancer.
Recent studies in gastric cancer clarify the optimal preoperative chemotherapy regimen and the use of PET scan as a response measure of preoperative therapy in esophagogastric cancer, and the role of targeted agents and immune checkpoint inhibitors in metastatic disease.
回顾食管癌和胃癌的近期研究。
食管癌和胃癌根治性治疗后的随访中，正电子发射断层扫描（PET）未提高生存率。在食管癌和胃癌的术前治疗中，与单纯化疗相比，在表柔比星、顺铂和5-氟尿嘧啶（5-FU；ECF）联合围手术期化疗基础上加用抗血管内皮生长因子药物贝伐单抗未能提高生存率。在局部晚期胃癌和食管胃腺癌术前化疗的头对头比较中，与ECF相比，FLOT（氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛）显著提高了总生存率。对PET无反应的患者在术前同步放化疗前评估诱导化疗反应，可在后续放疗期间改变化疗方案，提高病理完全缓解率。在人表皮生长因子受体-2阳性的晚期食管胃腺癌中，与使用紫杉醇化疗相比，化疗/曲妥珠单抗药物偶联物恩杂鲁胺/曲妥珠单抗二线治疗未能提高反应率或总生存率。免疫检查点抑制剂纳武单抗提高了难治性胃癌的生存率。
近期胃癌研究明确了最佳术前化疗方案、PET扫描作为食管癌和胃癌术前治疗反应指标的应用，以及靶向药物和免疫检查点抑制剂在转移性疾病中的作用。
