Patients with recurrent gastric cancer have cancer that has returned after primary treatment. Patients with refractory gastric cancer have cancer that has stopped responding to primary or secondary treatments.
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of recurrent or refractory gastric cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Patients experiencing progression of gastric cancer have been perceived to have few treatment options. Certain patients, however, can derive meaningful benefit from additional treatment. It is important for patients to be treated at a medical center that can offer multi-modality treatment involving medical oncologists, radiation oncologists, surgeons, gastroenterologists and nutritionists.
Chemotherapy is the main treatment for patients who have residual cancer after surgery or experience a cancer recurrence after surgery. Chemotherapy can relieve symptoms and extend survival among patients with advanced gastric cancer. Several chemotherapy regimens are available, and the choice of which to use depends in part on the patient’s health and prior treatments. Chemotherapy may be used alone or in combination with other treatments such as targeted therapy, radiation therapy, and/or surgery.
Targeted therapies are drugs that interfere with specific pathways involved in the growth or spread of cancer. In the case of some gastric cancers, a protein known as HER2 (human epidermal growth factor receptor 2) contributes to cancer growth. Metastatic gastric cancers that test positive for HER2 may be treated with a HER2-targeting drug called Herceptin® (trastuzumab). Herceptin is often used in combination with chemotherapy, and can prolong survival with advanced, HER2-positive gastric cancer.
Radiation therapy involves the use of a particular type of energy, known as ionizing radiation, to kill cancer cells. Radiation can play a role in managing the symptoms of advanced gastric cancer, and can also help to control problems such as bleeding or blockages.
For patients with recurrent gastric cancer, surgery may be performed in order to reduce bleeding or to keep the cancer from obstructing the intestines or stomach. To learn more about surgical treatment, go to Surgery and Gastric Cancer.
Prior to any surgical procedure, adequate preparation of the patient is important to minimize complications. Many patients with gastric cancer are malnourished at the time of diagnosis. Aggressive nutritional support has not been shown to improve long-term survival, but it has been shown to improve survival in the immediate post-operative period. Feeding intravenously and/or through a naso-gastric tube can enhance nutrition before surgery.
Strategies to Improve Treatment
The progress that has been made in the treatment of gastric cancer has resulted from the use of multi-modality treatment and improved patient and physician participation in clinical trials. Future progress in the treatment of gastric cancer will result from continued participation in appropriate trials. Currently, there are several areas of active exploration aimed at improving the treatment of gastric cancer.
Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.
New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials in patients with stage IV or recurrent gastric cancer.
Phase I Trials of Chemotherapy: New chemotherapy drugs continue to be developed and evaluated in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and to determine whether the drug has any anti-cancer activity in patients with gastric cancer. Phase I trials are usually performed in patients with recurrent or refractory cancer.
New Targeted Therapies: Several targeted therapies are being evaluated for the treatment of advanced gastric cancer. These targeted therapies include additional HER2-targeted drugs such as Tykerb® (lapatinib); other types of targeted therapies that have already been approved for other purposes, such as Avastin® (bevacizumab) and Afinitor® (everolimus); and new drugs that are being evaluated in several types of cancer.
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
. 2010; 376:687-697.