Liang H
Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Centerfor Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2021 Feb 25;24(2):107-111. doi: 10.3760/cma.j.cn.441530-20201215-00661.
Gastric cancer is one of the most common malignancy in China. Most of the patients of gastric cancer treated clinically are in advanced stage. In the past years, with the progress of anti-cancer drug therapy, after the comprehensive treatment based on drugs therapy of inoperative stage IV gastric cancer, some cases can reduce the tumor stage and get the opportunity of radical operation. Some of the patients who underwent surgical treatment can get the chance of long-term survival. The results of REGATTA trial confirmed that palliative surgery plus chemotherapy could not improve the long-term survival of patients with stage IV gastric cancer. Neoadjuvant intraperitoneal plus intravenous chemotherapy can reduce the tumor stage of some cases of stage IV gastric cancer with peritoneal metastasis and receive surgical treatment, so as to gain the chance of long-term survival. Regimen of intraperitoneal hyperthermia chemotherapy combined with PHOENIX trial is expected to improve the conversion operation rate of gastric cancer with peritoneal metastasis. Paclitaxel-based three-drug chemotherapy can reduce the tumor stage of some inoperable advanced gastric cancer and obtain the opportunity of radical operation, improving the disease-free survival rate and overall survival rate of patients, thus has become the cornerstone of conversion therapy for stage IV gastric cancer. Antiangiogenic targeted drug apatinib combined with paclitaxel is safe and reliable, and can be used as an alternative for the conversion therapy of stage IV gastric cancer, which provides a new idea for cytotoxic drugs combined with targeted drugs. In the era of immunotherapy, the combined application and first-line application of immunosuppressive drugs has become a clinical consensus. For advanced Her-2 positive esophagogastric junction adenocarcinoma cases, the successful exploration of the four-drug combination of chemotherapy+ anti-Her-2 targeted drugs+ anti-PD1 monoclonal antibody combined with the first-line therapy has opened up a new era of transformational therapy for stage IV gastric cancer. Gastric cancer is a malignant tumor with high heterogeneity, the classification of stage IV gastric cancer represented by Yoshida classification is based on imaging, and a more reasonable classification method should be developed in combination with gene detection in the future. Based on this, an individualized and accurate conversion therapy plan is formulated, so as to effectively improve the long-term survival of patients with stage IV gastric cancer.
胃癌是中国最常见的恶性肿瘤之一。临床上接受治疗的胃癌患者大多处于晚期。在过去几年中，随着抗癌药物治疗的进展，在对无法手术的IV期胃癌进行以药物治疗为基础的综合治疗后，部分病例可降低肿瘤分期并获得根治性手术的机会。一些接受手术治疗的患者能够获得长期生存的机会。REGATTA试验结果证实，姑息性手术加化疗并不能提高IV期胃癌患者的长期生存率。新辅助腹腔内联合静脉化疗可使部分伴有腹膜转移的IV期胃癌病例降低肿瘤分期并接受手术治疗，从而获得长期生存的机会。腹腔内热灌注化疗联合PHOENIX试验方案有望提高伴有腹膜转移胃癌的转化手术率。以紫杉醇为基础的三药联合化疗可使部分无法手术的晚期胃癌降低肿瘤分期并获得根治性手术的机会，提高患者的无病生存率和总生存率，因而成为IV期胃癌转化治疗的基石。抗血管生成靶向药物阿帕替尼联合紫杉醇安全可靠，可作为IV期胃癌转化治疗的替代方案，为细胞毒性药物联合靶向药物提供了新思路。在免疫治疗时代，免疫抑制药物的联合应用及一线应用已成为临床共识。对于晚期Her-2阳性食管胃交界腺癌病例，化疗+抗Her-2靶向药物+抗PD1单克隆抗体四药联合一线治疗的成功探索开启了IV期胃癌转化治疗的新时代。胃癌是一种高度异质性的恶性肿瘤，以吉田分类为代表的IV期胃癌分类基于影像学，未来应结合基因检测制定更合理的分类方法。在此基础上制定个体化、精准的转化治疗方案，以有效提高IV期胃癌患者的长期生存率。
