Cancer Treatment Today

Epidermal growth factor receptor (EGFR) is over-expressed in a significant proportion of esophageal and gastric carcinomas and there has been significant interest in targeting it. Unfortunately, it has not yet shown much progress. A phase II study by Chan et al showed minimal clinical activity of cetuximab.  A recent phase III trial, EXPAND (Erbitux in Combination With Xeloda and Cisplatin in Advanced Esophagogastric Cancer), involved 904 patients

Gastric cancer is known to have amplification of the ErbB2 (HER2) gene and Herceptin is supported for use in gastric cancer. Recently, there has been an interest in using Tyker(lapatinib) which is a drug that utalizes the same mechanism of action as Herceptin. One such trial is: LOGiC - Lapatinib Optimization Study in ErbB2 (HER2) Positive Gastric Cancer: A Phase III Global, Blinded Study Designed to Evaluate Clinical Endpoints and Safety of Chemotherapy

As compared with surgery alone, a North American Intergroup trial (INT 0116) demonstrated a clear survival benefit with the administration of a postoperative regimen of fluorouracil, leucovorin, and external beam radiation therapy, and these findings have made combined modality radiation and chemotherapy a standard of care in patients with resected gastric cancer. More recently, the British MRC Adjuvant Gastric Cancer Infusional Chemotherapy (MAGIC)

Gatrointestinal junction(GE) cancer (where esophagus and stomach meet) is a type of cancer that has similarities to both gastric and esophageal cancer. Since GE Junctions cancers that express HER turned out to respond well to Herceptin, there is great interest in targeting other molecules, such as the epidermal growth factor receptor, vascular endothelial growth factor receptor, and P13k/Akt/mTor pathway, as well as the insulin-like growth factor

Most cases of stage IV gastric cancer cannot be curatively treated with surgery alone, except for those with N3 or T4N2 cancers. Chemotherapy is therefore essentially palliative. There is no evidence of survival benefit for treatment modalities other than surgery for stage IV cancer, but some benefits are suggested for marginal life prolongation, tumor shrinkage, and relief of symptoms. Chemotherapy is indicated for patients with unresectable tumor

Lay Summary: Oxaluplatin combinations are sta Oxaliplatin based therapy is one of the options listed by NCCN for metastatic gastric cancer. The particular regimens that is being used has been extensively studies in Phase I (2) and III(2)I; there are also studies of capecitabine and oxaliplatin. A variety of different regimens have been studied in phase II trials (FOLFOX, EOF, XELOX [CAPOX], S1 plus oxaliplatin), all of which are associated with response

Lay Summary: Questions remain about pre-surgery chemo and radiation in stomach cancer that can be resected without these treatments. The practice of administering chemotherapy before surgery is referred to as neoadjuvant therapy. In theory, neoadjuvant chemotherapy can decrease the size of the cancer, thereby making it easier to remove with surgery. The major problems with this approach are the higher mortality rates that occur when radiation therapy

Chemosensitivity assays are controversial but most experts believe that they do not reliably assist in selecting chemotherapy. There is more evidence for chemoresistance assays but this also remains disputed. Chemoresistance assays are a modification that tests resistance to chemo rather than sensitivity. They work on the assumption that if celss show reesistance to very high concentrations of a drug in vitro, they will also be resistant in vivo

Lay Summary: Activity of Alimta for gastric cancer is supported by phase II studies. Gastric (stomach) cancer is the 14th most common cancer in the United States. Approximately 90% of gastric cancers are classified as adenocarcinomas, in reference to the type of cell within the stomach that the cancer originated. The main component of treatment for patients who cannot have their cancer surgically removed due to extent of spread and/or location of

Results from several randomized, placebo-controlled clinical trials for patients with primary gastrointestinal stromal tumor (GIST), a type of tumor usually found in the stomach or small intestine, showed that patients who received imatinib mesylate (Gleevec ®) after complete removal of their tumor were significantly less likely to have a recurrence of their cancer compared to those who did not receive imatinib. For example,  ACOSOG Z9001 trial