Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua 35100, Italy.
Surgical Pathology & Cytopathology Unit, Department of Medicine, University of Padua, Padua 35100, Italy.
World J Gastroenterol. 2019 Oct 14;25(38):5773-5788. doi: 10.3748/wjg.v25.i38.5773.
Gastric cancer (GC) represents a leading cause of cancer related morbidity and mortality worldwide accounting for more than 1 million of newly diagnosed cases and thousands of deaths every year. In the last decade, the development of targeted therapies and the optimization of already available chemotherapeutic drugs has expanded the available treatment options for advanced GC and granted better survival expectations to the patients. At the same time, global efforts have been undertaken to investigate in detail the genomic and epigenomic heterogeneity of this disease, resulting in the identification of new specific and sensitive predictive and prognostic biomarkers and in innovative molecular classifications based on gene expression profiling. Nonetheless, several randomized studies aimed at exploring new innovative agents, such as immune checkpoint inhibitors, failed to demonstrate clinically meaningful survival advantages. Therefore, it is essential to further improve the molecular characterization of GC subgroups in order to provide researchers and medical oncologists with new tools for patients' selection and stratification in future clinical development programs and subsequent trials. The aim of the present manuscript is to provide a global overview of the recent molecular classifications from The Cancer Genome Atlas and the Asian Cancer Research Group and to present key promising developments in the field of immunotherapy and targeted therapies in metastatic GC.
胃癌(GC)是全球癌症相关发病率和死亡率的主要原因,每年有超过 100 万例新诊断病例和数千例死亡。在过去的十年中,靶向治疗的发展和已有的化疗药物的优化扩大了晚期 GC 的治疗选择,并为患者带来了更好的生存预期。同时,全球努力详细研究了这种疾病的基因组和表观基因组异质性,从而确定了新的特异性和敏感性预测和预后生物标志物,并基于基因表达谱进行了创新性的分子分类。尽管如此,几项旨在探索免疫检查点抑制剂等新型创新药物的随机研究未能证明具有临床意义的生存优势。因此,进一步提高 GC 亚组的分子特征对于为研究人员和肿瘤内科医生提供新的工具以用于未来临床开发计划和后续试验中的患者选择和分层至关重要。本文的目的是提供来自癌症基因组图谱和亚洲癌症研究组的最新分子分类的全球概述,并介绍转移性 GC 中免疫治疗和靶向治疗领域的关键有前途的进展。