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Recent advances in the management of gastric adenocarcinoma patients

Gastric adenocarcinoma (GAC) is one of the most aggressive malignancies and has a dismal prognosis. Therefore, multimodality therapies to include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy are needed to provide advantage. For locally advanced GAC (>cT1B), the em...

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Autores principales: Harada, Kazuto, Lopez, Anthony, Shanbhag, Namita, Badgwell, Brian, Baba, Hideo, Ajani, Jaffer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: F1000 Research Limited 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117861/
https://www.ncbi.nlm.nih.gov/pubmed/30228868
http://dx.doi.org/10.12688/f1000research.15133.1
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author Harada, Kazuto
Lopez, Anthony
Shanbhag, Namita
Badgwell, Brian
Baba, Hideo
Ajani, Jaffer
author_facet Harada, Kazuto
Lopez, Anthony
Shanbhag, Namita
Badgwell, Brian
Baba, Hideo
Ajani, Jaffer
author_sort Harada, Kazuto
collection PubMed
description Gastric adenocarcinoma (GAC) is one of the most aggressive malignancies and has a dismal prognosis. Therefore, multimodality therapies to include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy are needed to provide advantage. For locally advanced GAC (>cT1B), the emerging strategies have included preoperative chemotherapy, postoperative adjuvant chemotherapy, and (occasionally) postoperative chemoradiation in various regions. Several novel therapies have been assessed in clinical trials, but only trastuzumab and ramucirumab (alone and in combination with paclitaxel) have shown overall survival advantage. Pembrolizumab has been approved by the US Food and Drug Administration on the basis of response rate only for patients with microsatellite instability (MSI-H) or if PD-L1 expression is positive (≥1% labeling index in tumor/immune cells in the presence of at least 100 tumor cells in the specimen). Nivolumab has been approved in Japan on the basis of a randomized trial showing significant survival advantage for patients who received nivolumab compared with placebo in the third or later lines of therapy. The cure rate of patients with localized GAC in the West is only about 40% and that for metastatic cancer is very poor (only 2–3%). At this stage, much more target discovery is needed through molecular profiling. Personalized therapy of patients with GAC remains a challenge.
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spelling pubmed-61178612018-09-17 Recent advances in the management of gastric adenocarcinoma patients Harada, Kazuto Lopez, Anthony Shanbhag, Namita Badgwell, Brian Baba, Hideo Ajani, Jaffer F1000Res Review Gastric adenocarcinoma (GAC) is one of the most aggressive malignancies and has a dismal prognosis. Therefore, multimodality therapies to include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy are needed to provide advantage. For locally advanced GAC (>cT1B), the emerging strategies have included preoperative chemotherapy, postoperative adjuvant chemotherapy, and (occasionally) postoperative chemoradiation in various regions. Several novel therapies have been assessed in clinical trials, but only trastuzumab and ramucirumab (alone and in combination with paclitaxel) have shown overall survival advantage. Pembrolizumab has been approved by the US Food and Drug Administration on the basis of response rate only for patients with microsatellite instability (MSI-H) or if PD-L1 expression is positive (≥1% labeling index in tumor/immune cells in the presence of at least 100 tumor cells in the specimen). Nivolumab has been approved in Japan on the basis of a randomized trial showing significant survival advantage for patients who received nivolumab compared with placebo in the third or later lines of therapy. The cure rate of patients with localized GAC in the West is only about 40% and that for metastatic cancer is very poor (only 2–3%). At this stage, much more target discovery is needed through molecular profiling. Personalized therapy of patients with GAC remains a challenge. F1000 Research Limited 2018-08-30 /pmc/articles/PMC6117861/ /pubmed/30228868 http://dx.doi.org/10.12688/f1000research.15133.1 Text en Copyright: © 2018 Harada K et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Harada, Kazuto
Lopez, Anthony
Shanbhag, Namita
Badgwell, Brian
Baba, Hideo
Ajani, Jaffer
Recent advances in the management of gastric adenocarcinoma patients
title Recent advances in the management of gastric adenocarcinoma patients
title_full Recent advances in the management of gastric adenocarcinoma patients
title_fullStr Recent advances in the management of gastric adenocarcinoma patients
title_full_unstemmed Recent advances in the management of gastric adenocarcinoma patients
title_short Recent advances in the management of gastric adenocarcinoma patients
title_sort recent advances in the management of gastric adenocarcinoma patients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117861/
https://www.ncbi.nlm.nih.gov/pubmed/30228868
http://dx.doi.org/10.12688/f1000research.15133.1
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