Yang Heli, Ji Ke, Ji Jiafu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Chin J Cancer Res. 2022 Apr 30;34(2):109-114. doi: 10.21147/j.issn.1000-9604.2022.02.05.
The concept and strategy of advanced gastric cancer treatment have gradually undergone profound changes with the in-depth understanding of the biology and heterogeneous characteristics of gastric cancer. Moreover, the development and application of new anticancer drugs, including chemotherapy drugs, molecularly targeted drugs and immunotherapy drugs for advanced gastric cancer are reported. The connotation of conversion therapy refers to the unresectable or borderline resectable tumors for surgical technical and/or oncological reasons, after active and effective chemotherapy and other comprehensive treatment, the primary gastric lesions can be reduced to a lower stage, while the metastatic lesions can be effectively controlled, to achieve R0 resection and improve the long-term survival rate. Current promising research results of conversion therapy are mostly from single-arm phase II clinical studies with small samples or retrospective studies. Conversion therapy still faces many challenges, including limited diagnostic and assessment methods, insufficient evidence of highly effective treatment regimens, difficulty in clarifying surgical indications, etc. Therefore, the integrated conversion therapy for advanced gastric cancer needs to be carried out with the close cooperation of a multidisciplinary team. Prospective, multi-center randomized controlled trial studies should be conducted in the future, and precision medicine such as molecular biology should be combined to provide better anticancer drug regimens and higher-level clinical evidence for conversion therapy of advanced gastric cancer.
随着对胃癌生物学及异质性特征认识的不断深入，晚期胃癌的治疗理念与策略逐渐发生了深刻变化。此外，还报道了晚期胃癌新型抗癌药物的研发与应用，包括化疗药物、分子靶向药物及免疫治疗药物。转化治疗的内涵是指因手术技术和/或肿瘤学原因而不可切除或边界可切除的肿瘤，经过积极有效的化疗等综合治疗后，原发胃病变可降期，同时转移灶可得到有效控制，从而实现R0切除并提高长期生存率。目前转化治疗有前景的研究结果大多来自小样本单臂II期临床研究或回顾性研究。转化治疗仍面临诸多挑战，包括诊断和评估方法有限、高效治疗方案证据不足、难以明确手术指征等。因此，晚期胃癌的综合转化治疗需要多学科团队密切协作开展。未来应进行前瞻性、多中心随机对照试验研究，并结合分子生物学等精准医学手段，为晚期胃癌转化治疗提供更好的抗癌药物方案及更高水平的临床证据。
