Skip to main content

Advertisement

SpringerLink
Log in

Updates on Management of Gastric Cancer

  • Gastrointestinal Cancers (J Meyer, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Gastric adenocarcinoma is the fifth most common and the third most lethal cancer worldwide. Surgery is the only chance of cure, but recurrence is common, even with complete resection.

Recent Findings

Advances in diagnosis and staging, genomic classification, surgical resection and treatment of peritoneal disease, systemic chemotherapy and chemoradiation, and targeted and immune therapies have led to the current multidisciplinary approach to gastric adenocarcinoma.

Summary

Treatment of gastric cancer is rapidly evolving in an effort to combat this challenging disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  2. LAURÉN P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand. 1965;64(1):31–49. https://doi.org/10.1111/apm.1965.64.1.31.

    Article  PubMed  Google Scholar 

  3. WHO Classification of Tumours of the Digestive System. Fourth Edition - WHO - OMS -. http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=70&codcch=4003. Accessed February 26, 2019.

  4. Curtis NJ, Noble F, Bailey IS, Kelly JJ, Byrne JP, Underwood TJ. The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro-oesophageal junction. J Surg Oncol. 2014;109(3):202–7. https://doi.org/10.1002/jso.23484.

    Article  PubMed  Google Scholar 

  5. Rüdiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000;232(3):353–361. http://www.ncbi.nlm.nih.gov/pubmed/10973385 . Accessed March 6, 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bass AJ, Thorsson V, Shmulevich I, et al. Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 2014;513(7517):202–9. https://doi.org/10.1038/nature13480.

    Article  CAS  Google Scholar 

  7. Cristescu R, Lee J, Nebozhyn M, Kim KM, Ting JC, Wong SS, et al. Molecular analysis of gastric cancer identifies subtypes associated with distinct clinical outcomes. Nat Med. 2015;21(5):449–56. https://doi.org/10.1038/nm.3850.

    Article  CAS  PubMed  Google Scholar 

  8. Fonkoua LK, Yee NS. Biomedicines molecular characterization of gastric carcinoma: therapeutic implications for biomarkers and targets. doi:https://doi.org/10.3390/biomedicines6010032, 2018.

    Article  PubMed Central  Google Scholar 

  9. Leake P-A, Cardoso R, Seevaratnam R, Lourenco L, Helyer L, Mahar A, et al. A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer. Gastric Cancer. 2012;15(S1):38–47. https://doi.org/10.1007/s10120-011-0047-z.

    Article  Google Scholar 

  10. Amin MB, Edge SB, American Joint Committee on Cancer. AJCC Cancer Staging Manual. https://www.springer.com/us/book/9783319406176. Accessed February 25, 2019. The 8 th edition AJCC Cancer Staging Manual for gastric cancer is integral for clinical practice. It has been updated with evidence-based clinical and post-neoadjuvant staging systems for facilitation of initial treatment plan recommendations.

  11. Shu P, Qin J, Shen K, Chen W, Liu F, Fang Y, et al. The IGCA staging system is more accurate than AJCC7 system in stratifying survival of patients with gastric cancer in stage III. BMC Cancer. 2017;17(1):238. https://doi.org/10.1186/s12885-017-3235-3.

  12. Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev. 2015;2:CD009944. https://doi.org/10.1002/14651858.CD009944.pub2.

    Article  Google Scholar 

  13. Puli S-R, Reddy J-B, Bechtold M-L, Antillon D, Ibdah J-A, Antillon M-R. Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol 2008;14(10):1479–1490. http://www.ncbi.nlm.nih.gov/pubmed/18330935 . Accessed March 6, 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rosenbaum SJ, Stergar H, Antoch G, Veit P, Bockisch A, Kühl H. Staging and follow-up of gastrointestinal tumors with PET/CT. Abdom Imaging. 2006;31(1):25–35. https://doi.org/10.1007/s00261-005-0031-3.

    Article  CAS  PubMed  Google Scholar 

  15. Lisa Gurski N, McMillian N, Lenora Pluchino MA, et al. NCCN Guidelines Version 2.2018 Panel Members Gastric Cancer.; 2019. https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed February 26, 2019. The NCCN Guidelines for gastric cancer are comprehensive, evidence-based, and frequently updated. They are compiled and published by a panel of experts in the field.

  16. De Andrade JP, Mezhir JJ. The critical role of peritoneal cytology in the staging of gastric cancer: an evidence-based review. J Surg Oncol. 2014;110(3):291–7. https://doi.org/10.1002/jso.23632.

    Article  PubMed  Google Scholar 

  17. The general rules for The gastric cancer study in surgery. Jpn J Surg. 1973;3(1):61–71. http://www.ncbi.nlm.nih.gov/pubmed/4803902. Accessed February 26, 2019.

  18. Songun I, Putter H, Kranenbarg EM-K, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49. https://doi.org/10.1016/S1470-2045(10)70070-X.

    Article  PubMed  Google Scholar 

  19. Mocellin S, McCulloch P, Kazi H, Gama-Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2015;8:CD001964. https://doi.org/10.1002/14651858.CD001964.pub4.

    Article  Google Scholar 

  20. Fujimura T, Nakamura K, Oyama K, et al. Selective lymphadenectomy of Para-aortic lymph nodes for advanced gastric cancer. Oncol Rep 2009;22(3):509–514. http://www.ncbi.nlm.nih.gov/pubmed/19639196 . Accessed February 26, 2019.

  21. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14(2):317–28. https://doi.org/10.1245/s10434-006-9218-2.

    Article  PubMed  Google Scholar 

  22. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4(2):146–148. http://www.ncbi.nlm.nih.gov/pubmed/8180768 . Accessed February 26, 2019.

  23. Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surg Clin North Am. 2003;83(6):1429–44. https://doi.org/10.1016/S0039-6109(03)00158-0.

    Article  PubMed  Google Scholar 

  24. Huscher CGS, Mingoli A, Sgarzini G, Sansonetti A, di Paola M, Recher A, Ponzano C Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 2005;241(2):232–237. http://www.ncbi.nlm.nih.gov/pubmed/15650632 . Accessed February 28, 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol. 2005;23(20):4490–8. https://doi.org/10.1200/JCO.2005.19.935.

    Article  PubMed  Google Scholar 

  26. Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012;76(4):763–70. https://doi.org/10.1016/j.gie.2012.06.014.

    Article  PubMed  Google Scholar 

  27. Facciorusso A, Antonino M, Di Maso M, Muscatiello N. Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: a meta-analysis. World J Gastrointest Endosc. 2014;6(11):555–63. https://doi.org/10.4253/wjge.v6.i11.555.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wagner AD, Syn NL, Moehler M, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev. 2017;8. https://doi.org/10.1002/14651858.CD004064.pub4.

  29. Hall J, Loggie BW, Shen P, et al. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer. J Gastrointest Surg. 2004;8(4):454–63. https://doi.org/10.1016/j.gassur.2003.12.014.

    Article  PubMed  Google Scholar 

  30. Glehen O, Gilly FN, Arvieux C, et al. Peritoneal Carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17(9):2370–7. https://doi.org/10.1245/s10434-010-1039-7.

    Article  PubMed  Google Scholar 

  31. Gill RS, Al-Adra DP, Nagendran J, et al. Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol. 2011;104(6):692–8. https://doi.org/10.1002/jso.22017.

    Article  PubMed  Google Scholar 

  32. Bonnot PE, Piessen G, Pocard M, Meunier B, Bereder JM, Abboud K, et al. CYTO-CHIP: cytoreductive surgery versus cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis: a propensity-score analysis from BIG RENAPE and FREGAT working groups. J Clin Oncol. 2018;36(4_suppl):8–8. https://doi.org/10.1200/JCO.2018.36.4_suppl.8 . The CYTO-CHIP analysis data has only recently been reported, and provides evidence of survival benefit of cytoreductive surgery plus HIPEC in gastric cancer in patients with evidence of peritoneal disease.

    Article  Google Scholar 

  33. Desiderio J, Chao J, Melstrom L, Warner S, Tozzi F, Fong Y, et al. The 30-year experience—a meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer. Eur J Cancer. 2017;79:1–14. https://doi.org/10.1016/j.ejca.2017.03.030.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cunningham D, Allum WH, Stenning SP, Thompson JN, van de Velde C, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20. https://doi.org/10.1056/NEJMoa055531.

    Article  CAS  PubMed  Google Scholar 

  35. Al-Batran S-E, Homann N, Schmalenberg H, et al. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): a multicenter, randomized phase 3 trial. J Clin Oncol. 2017;35(15_suppl):4004–4. https://doi.org/10.1200/JCO.2017.35.15_suppl.4004 The FLOT regimen recently showed improved survival over previous chemotherapy regimens in the perioperative setting. This has caused a dramatic change in the chemotherapeutic treatment of gastric cancer over a brief period of time.

    Article  Google Scholar 

  36. Moertel C, Reitemeier R, Childs D, Colby M, Holbrook M. Combined 5-fluorouracil and SUPERVOLTAGE radiation therapy of locally UNRESECTABLE gastrointestinal cancer. Lancet. 1969;294(7626):865–7. https://doi.org/10.1016/S0140-6736(69)92326-5.

    Article  Google Scholar 

  37. Gastrointestinal Tumor Study Group. A comparison of combination chemotherapy and combined modality therapy for locally advanced gastric carcinoma. Cancer. 1982;49(9):1771–7 http://www.ncbi.nlm.nih.gov/pubmed/6176313 . Accessed February 28, 2019.

    Article  Google Scholar 

  38. Smalley SR, Benedetti JK, Haller DG, Hundahl SA, Estes NC, Ajani JA, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012;30(19):2327–33. https://doi.org/10.1200/JCO.2011.36.7136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Cats A, Jansen EPM, van Grieken NCT, Sikorska K, Lind P, Nordsmark M, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. Lancet Oncol. 2018;19(5):616–28. https://doi.org/10.1016/S1470-2045(18)30132-3.

    Article  CAS  PubMed  Google Scholar 

  40. Leong T, Smithers BM, Haustermans K, Michael M, Gebski V, Miller D, et al. TOPGEAR: a randomized, phase III trial of perioperative ECF chemotherapy with or without preoperative chemoradiation for resectable gastric cancer: interim results from an international, intergroup trial of the AGITG, TROG, EORTC and CCTG. Ann Surg Oncol. 2017;24(8):2252–8. https://doi.org/10.1245/s10434-017-5830-6.

    Article  PubMed  Google Scholar 

  41. Lee J, Lim DH, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012;30(3):268–73. https://doi.org/10.1200/JCO.2011.39.1953.

    Article  CAS  PubMed  Google Scholar 

  42. Park SH, Lee SJ, Kim ST, Lee J, Park JO, Park YS, et al. Multicenter phase III trial of adjuvant chemoradiotherapy in stomach tumors 2 (ARTIST 2). J Clin Oncol. 2015;33(3_suppl:TPS228–8. https://doi.org/10.1200/jco.2015.33.3_suppl.tps228.

    Article  Google Scholar 

  43. van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, Henegouwen MIB, Wijnhoven BPL, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84. https://doi.org/10.1056/NEJMoa1112088.

    Article  CAS  PubMed  Google Scholar 

  44. Hoeppner J, Lordick F, Brunner T, Glatz T, Bronsert P, Röthling N, et al. ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer. 2016;16(1):503. https://doi.org/10.1186/s12885-016-2564-y.

  45. Gravalos C, Jimeno A. HER2 in gastric cancer: a new prognostic factor and a novel therapeutic target. Ann Oncol. 2008;19(9):1523–9. https://doi.org/10.1093/annonc/mdn169.

    Article  CAS  PubMed  Google Scholar 

  46. Bang Y-J, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet (London, England). 2010;376(9742):687–97. https://doi.org/10.1016/S0140-6736(10)61121-X.

    Article  CAS  Google Scholar 

  47. Satoh T, Lee KH, Rha SY, Sasaki Y, Park SH, Komatsu Y, et al. Randomized phase II trial of nimotuzumab plus irinotecan versus irinotecan alone as second-line therapy for patients with advanced gastric cancer. Gastric Cancer. 2015;18(4):824–32. https://doi.org/10.1007/s10120-014-0420-9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet (London, England). 2014;383(9911):31–9. https://doi.org/10.1016/S0140-6736(13)61719-5.

    Article  CAS  Google Scholar 

  49. Wilke H, Muro K, Van Cutsem E, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014;15(11):1224–35. https://doi.org/10.1016/S1470-2045(14)70420-6.

    Article  CAS  PubMed  Google Scholar 

  50. Kang Y-K, Boku N, Satoh T, Ryu MH, Chao Y, Kato K, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet (London, England). 2017;390(10111):2461–71. https://doi.org/10.1016/S0140-6736(17)31827-5.

    Article  CAS  Google Scholar 

  51. Muro K, Chung HC, Shankaran V, Geva R, Catenacci D, Gupta S, et al. Pembrolizumab for patients with PD-L1-positive advanced gastric cancer (KEYNOTE-012): a multicentre, open-label, phase 1b trial. Lancet Oncol. 2016;17(6):717–26. https://doi.org/10.1016/S1470-2045(16)00175-3.

    Article  CAS  PubMed  Google Scholar 

  52. Bang Y-J, Cho JY, Kim YH, Kim JW, di Bartolomeo M, Ajani JA, et al. Efficacy of sequential ipilimumab monotherapy versus best supportive care for unresectable locally advanced/metastatic gastric or gastroesophageal junction cancer. Clin Cancer Res. 2017;23(19):5671–8. https://doi.org/10.1158/1078-0432.CCR-17-0025.

    Article  CAS  PubMed  Google Scholar 

  53. Janjigian YY, Bendell J, Calvo E, Kim JW, Ascierto PA, Sharma P, et al. CheckMate-032 study: efficacy and safety of Nivolumab and Nivolumab plus Ipilimumab in patients with metastatic Esophagogastric Cancer. J Clin Oncol. 2018;36(28):2836–44. https://doi.org/10.1200/JCO.2017.76.6212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Moehler M, Ryu M-H, Dvorkin M, Lee KW, Coşkun HŞ, Wong R, et al. Maintenance avelumab versus continuation of first-line chemotherapy in gastric cancer: JAVELIN gastric 100 study design. Future Oncol. 2019;15(6):567–77. https://doi.org/10.2217/fon-2018-0668.

    Article  CAS  PubMed  Google Scholar 

  55. Bang Y-J, Ruiz EY, Van Cutsem E, et al. Phase III, randomised trial of avelumab versus physician’s choice of chemotherapy as third-line treatment of patients with advanced gastric or gastro-oesophageal junction cancer: primary analysis of JAVELIN Gastric 300. Ann Oncol. 2018;29(10):2052–60. https://doi.org/10.1093/annonc/mdy264.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Gastrointestinal Surgical Oncology, Peritoneal Surface Malignancy Program, Division of Surgical Oncology, Johns Hopkins University, 600 N. Wolfe Street/Blalock 606, Baltimore, MD, 21287, USA

    Fabian M. Johnston

  2. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street/Blalock 665, Baltimore, MD, 21287, USA

    Michael Beckman

Authors
  1. Fabian M. Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Beckman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabian M. Johnston.

Ethics declarations

Conflict of Interest

Fabian M. Johnston and Michael Beckman declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Gastrointestinal Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johnston, F.M., Beckman, M. Updates on Management of Gastric Cancer. Curr Oncol Rep 21, 67 (2019). https://doi.org/10.1007/s11912-019-0820-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-019-0820-4

Keywords

Search

Navigation