Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie, Klinikum rechts der Isar, Munich, Germany,
Klinik für Internistische Onkologie & Hämatologie mit integrierter Palliativmedizin, Evang. Kliniken Essen-Mitte, Essen, Germany.
Oncol Res Treat. 2020;43(1-2):42-47. doi: 10.1159/000503428. Epub 2019 Oct 21.
Adenocarcinoma of the stomach and esophagogastric junction (EGJ) remains a tumor entity with a poor prognosis. While meaningful advances have been made in the treatment of other solid tumors in the past years, numerous phase III studies in gastric cancer have had negative outcomes. Successes of targeted therapies so far include the -introduction of trastuzumab in the first-line treatment of HER2-positive gastric cancer, and second-line anti-angiogenic treatment with the anti-VEGF-2 receptor antibody ramucirumab. Taxanes have become established in the perioperative setting and in second-line treatment and have set new standards. However, evidence for improved overall survival in the first-line treatment of advanced gastric cancer with taxanes is not convincing.
Expert consensus discussion on the scientific and clinical evidence for sequential systemic treatment for advanced gastric and EGJ cancer, taking into account data clinical outcomes from randomized controlled phase II and phase III trials.
In first-line treatment of advanced gastric cancer, taxanes in combination with a platinum- and 5-fluorouracil-based regimen are generally not recommended because they lack a survival benefit and confer high toxicity. However, taxanes in first-line can be a treatment option for patients presenting with high tumor burden and strong pressure to achieve remission. Since the publication of several positive studies in second- and third-line therapy, sequential therapy is playing an increasingly important role in metastatic gastric and EGJ cancer. Key Message: Standard of care for the first-line treatment of gastric cancer is a platinum-fluoropyrimidine chemotherapy doublet combination. The standard of care after failure of platinum-based first-line therapy is ramucirumab in combination with paclitaxel. Data supporting this combination after previous taxane therapy are not yet available.
胃和食管胃交界腺癌（EGJ）仍然是一种预后较差的肿瘤实体。虽然近年来在治疗其他实体肿瘤方面取得了重大进展，但在胃癌的众多 III 期研究中，结果均为阴性。迄今为止，靶向治疗的成功案例包括曲妥珠单抗在 HER2 阳性胃癌一线治疗中的应用，以及抗血管生成治疗药物 ramucirumab 二线治疗。紫杉烷在围手术期和二线治疗中已得到广泛应用，并确立了新的标准。然而，紫杉烷在晚期胃癌一线治疗中提高总生存期的证据并不令人信服。
专家就晚期胃和 EGJ 癌序贯系统治疗的科学和临床证据进行了共识讨论，同时考虑了来自随机对照 II 期和 III 期试验的临床数据和结果。
在晚期胃癌的一线治疗中，紫杉烷联合铂类和氟尿嘧啶类方案通常不推荐使用，因为它们没有生存获益，且毒性较高。然而，对于肿瘤负荷较高且强烈要求缓解的患者，紫杉烷可作为一线治疗的选择。由于二线和三线治疗的几项阳性研究的发表，序贯治疗在转移性胃和 EGJ 癌中发挥着越来越重要的作用。关键信息：胃腺癌一线治疗的标准方案是铂类氟嘧啶类化疗双联方案。铂类一线治疗失败后的标准治疗方案是 ramucirumab 联合紫杉醇。关于先前紫杉烷治疗后该联合方案的数据尚不可用。
