Treatment Strategy of Patients with Unresectable Advanced or Recurrent Gastric Cancer

Abstract

The combination therapy of S-1 and cisplatin(CS) is widely used for the first line therapy of the patients with unselected advanced gastric cancer (AGC) in Japan, but its outcomes remains poor. In order to develop further effective treatment, a randomized phase III trial comparing triplet therapy, docetaxel adding to CS, and CS is now ongoing (JCOG 1013). For the second line therapy for unselected AGC patients, it was reported in ASCO-GI 2014 that ramucirumab, a fully human monoclonal antibody against VEGFR-2, with paclitaxel significantly prolonged survival (RAINBOWtrial), as well as ramucirumab monotherapy vs BSC (REGARD trial). Because the paclitaxel monotherapy in the second line is widely used in Japan, the insurance approval of ramucirumab is desired in Japan. For HER2 positive AGC patients, of phase III trial of anti-HER2 therapy is now undergoing; as first-line treatment, pertuzumab in combination with trastuzumab, fluoropyrimidine and cisplatin, and as second line, comparing trastuzumab emtansine (T-DM1) and taxane. The treatment other than those targeted to HER2, clinical trials targeting MET is progressing.