Today the treatment of upper gastrointestinal malignancies still represent an unmet medical need, both in European and Asian countries, despite their incidence rate is increasing globally. While oncologists could count on wider tools of treatment for colorectal cancer, generally a limited number of biological drugs have shown to be effective in gastric cancer and early detection is limited. “The attention on gastric cancer though is rising in Western countries as a large amount of new cases is reported”, states Prof Roberto Labianca, Director of the Cancer Canter at Ospedale Giovanni XXIII, Bergamo, Italy. “Research efforts are focusing on immunotherapy, which is providing evidence of benefit for different type of tumours, and on the development of novel drugs. We are now looking with interest to a new monoclonal antibody, ramucirumab, which has been tested in the last 2-3 years.”
Effective chemotherapy with mild toxicity for treatment of advanced gastric cancer is limited too. Combining paclitaxel and capecitabine as first-line chemotherapy followed by capecitabine monotherapy as maintenance therapy might improve quality of life and lower toxicity in patients with advanced gastric cancer, according to data from a multicentre, randomised, Phase III study (144O) presented at the ESMO Asia Congress. “Although this is not yet a new standard of care, the combination therapy followed by maintenance treatment versus the standard treatment, which is cisplatin and capecitabine, appears to be slightly better in terms of tolerance, quality of life, toxicity and also in terms of response rate”.
A major critical issue is to identify patients with high risk of relapse after gastric cancer resection. “Adjuvant chemotherapy can be useful after surgery, but currently there is no standard to select patients who could benefit the most from this strategy”. A Chinese research evaluating plasma miRNA-based signatures as prognostic tools for predicting 3-year postoperative recurrence risk for patients with stage II and III gastric cancer (27PD), found that 7 mRNA could have a predictive effect. “The study doesn’t define a new standard classification of patients but it suggests a very helpful way to identify those with high risk of relapse”, says Labianca.
Besides any progress in therapeutic approach, screening programmes for gastric cancer represent a challenge. “The best screening strategy would be to perform a gastroscopy every 2 or 3 years which is not well-accepted by healthy people. There are no screening programmes in Europe and US”, concludes Labianca. The situation is slightly different in Asia. “In Japan, a large population-screening programme helped to detect many patients with early gastric cancer, with a positive impact on reducing cancer-related mortality”.
Proffered Paper session: Gastrointestinal tumours 2, 20 December, 14:30 to 15:45, Hall
Absract 144O Comparison of efficacy and safety of paclitaxel and capecitabine followed by capecitabine as maintenance therapy versus cisplatin and capecitabine therapy for advanced gastric