Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
권호 표지

Oncological Treatment of Advanced Gastric Cancer

진행성 위암의 항암 약물 요법에 대하여

  • Hee Seok Moon (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Hyun Yong Jeong (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital)
  • 문희석 (충남대학교 의과대학 내과학교실, 소화기내과) ;
  • 정현용 (충남대학교 의과대학 내과학교실, 소화기내과)
  • Received : 2018.06.11
  • Accepted : 2018.06.13
  • Published : 2018.06.30
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Abstract

Gastric cancer is not a single, uniform disease, but rather heterogeneous in nature. It is generally not possible to cure patients with inoperable advanced or metastatic stomach cancer. In the absence of chemotherapy, the median survival time is 3 to 6 months. Therefore, several studies have confirmed the superiority of chemotherapy to the best supportive treatment, in terms of improving the quality of life and prolonging life. Various chemotherapies have been used in the past to treat advanced gastric cancer. Recently, various target therapies and immunotherapy have been introduced. However, compared to other malignancies, the quality of life and life expectancy remain relatively poor in patients with gastric cancer. We expect to overcome these difficulties in the future, with better elucidation of the molecular biology of gastric cancer.

위암은 최근에 균일한 성격의 단일 질환이 아니라, 매우 이질적인 질환으로 인식되고 있다. 수술이 불가능한 진행성 또는 전이성 위암의 경우 일반적으로 완치가 불가능하며 항암치료를 하지 않는 경우 중앙 생존기간이 3-6개월 정도로 알려져 있다. 따라서 항암치료를 하는 경우가 최선의 지지 치료에 비하여 삶의 질이나 생명연장의 측면에서 우월함을 이미 여러 연구를 통해서 확인되고 있다. 지난 기간 동안 다양한 항암치료가 진행성 위암의 치료에 적용되었고, 최근에 여러 표적 치료와 면역치료가 도입되고 있으나, 여전히 다른 암종에 비하여 진행성 위암환자에서는 현저한 생명연장은 아직 저조하고 답보 상태에 있다. 그러나 향후 위암의 분자생물학적인 특성이 자세히 알려지면서 이러한 어려움들은 극복될 것으로 기대된다.

Keywords

References

  1. Cancer inspected through statistics. [Internet]. Goyang: National Cancer Information Center; 2015[cited 2017 DCB 17]. Available from: http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_040101000000.
  2. http://globacan.iarc.fr: GLOBACAN 2012: Estimated Cancer Incidance, Mortality and Prevalence Worldwide in 2012.
  3. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20.
  4. Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone forresectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011;29:1715-1721.
  5. Schuhmacher C, Gretschel S, Lordick F, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 2010;28:5210-5218.
  6. Group G, Paoletti X, Oba K et al. Benefit of adjuvant chemotheraphy for resectable gastric cancer; a meta analysis. JAMA 2010;303:1729-1737.
  7. Sasako M, Sakuramoto S, Katai H, et al. Five year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011;379:315-321.
  8. Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow up of an open label, randomised phase 3 trial. Lancet Oncol 2014;15:1389-1396.
  9. Tsuburaya A, Yoshida K, Kobayashi M, et al. Sequential paclitaxel followed by tegafur and uracil (UFT) or S-1 versus UFT or S-1 monotherapy as adjuvant chemotherapy for T4a/b gastric cancer (SAMIT): a phase 3 factorial randomized controlled trial. Lancet Oncol 2014:15:886-893.
  10. Macdonald JS, Smalley SR, Benedetti J et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophgeal junction. N Engl J Med 2001;345:725-730.
  11. Lee J, Lim do H, Kim S, et al. Phase III trial comparing capecitabine plus cisplatin versus capecit abine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: ARTIST trial. J Clin Oncol 2012;30:268-273.
  12. Webb A, Cunningham D, Scarffe JH, et al: Randomized trial comparing epirubicin, cisplatin and fluorouracil versus fluorouracil, doxorubicin and methotrexate in advanced esophago gastric cancer. J Clin Oncol 1997;15:261-267.
  13. Boku N, Yamamoto S, Fukuda H et al. Fluorouracil versus combination of irinotecan plus cisplatinversus S-1 in metastatic gastric cancer: a randomized phase 3 study. Lancet Oncol 2009;10:1063-1069.
  14. Koizumi W, Narahara H, Hara T et al: S-1 plus cisplatin versus S-1 alone for first line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 2008;9:215-221.
  15. Kang YK, Kang WK, Shin DB et al: Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first line therapy in patients with advanced gastric cancer: a randomised phase III non-inferiority trial. Ann Oncol 2009;20:666-673.
  16. Cunningham D, Starling N, Rao S et al: Capecitabine and oxaliplatin for advanced esophago gastric cancer. N Engl J Med 2008;358:36-46.
  17. Al-Batran SE, Hartmann JT, Probst S et al: Phase III trial in metastatic gastroesophagealadenoca rcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkolgie. J Clin Oncol 2008;26:1435-1442.
  18. Bouche O, Raoul JL, Bonnetain F, et al Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecanIn patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study(FFCD9803). J Clin Oncol 2004;22:4319.
  19. Guimbaud R, Louvet C, Ries P, et al. Prospective, randomized, multicenter, phase III study of Fluorouracil, leucovorin, and irinotecan versus epirubicin, cisplatin, and capecitabine in advanced gastric adenocarcinoma. J Clin Oncol 2014;32:3520-3526.
  20. Van Cutsem E, Moiseyenko VM, Tjulandin S et al: Phase III study of docetaxel and cisplastin plus fluorouracil compared with cisplatin and fluorouracil as first line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006;24:4991-4997.
  21. Kang JH, Lee SI, Lim DH et al Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care alone. J Clin Oncol 2012;30:1513-1518.
  22. Cook N, Marshall A, Blazeby JM et al: A randomized phase III study of docetaxel versus active symptom control in patients with relapsed esophago-gastric adenocarcinoma. J Clin Oncol. 2013;31:(Supplabstr 4023).
  23. Bang YJ, 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, randomized controlled trial. Lancet 2010;376;687-697.
  24. Lordick F, Kang YK, Chung HC et al: Capecitabe and Cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open labe phase 3 trial. Lancet Oncol 2013;14;490-499.
  25. Ohtsu A, Shah MA, Van Cutsem E et al: Bevacizumab in combination with chemotherapy as first line therapy in advanced gastric cancer: a randomized double placebo- controlled phase III study. J Clin Oncol 2011;29;3968-3976.
  26. Fuchs CS, Tomasek J, Yong CJ. et al. Ramucirumabmonotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomized, multicentre, placebo-controlled, phase 3 trial. Lancet 2014:383:31-39.
  27. 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;15:1224-1235.
  28. Qin S. Phase III Study of apatinib in advanced gastric cancer: A randomized, double-blind, placebo-controlled trial. J Clin Oncol 2014;(suppl: abstr 4003).
  29. Kang YK, Boku N, Satoh T, Ryu NH et al. Nivolumab in patients with advanced gastric or gastro-esophageal 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 2017;390:2461-2471.