• Journal of Gastric Cancer
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• 제17권2호
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• pp.120-131
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• 2017

Purpose: Tumor bleeding is a major complication in inoperable gastric cancer. The study aim was to investigate the effects of proton pump inhibitor (PPI) treatment for the prevention of gastric tumor bleeding. Materials and Methods: This study was a prospective double-blind, randomized, placebo-controlled trial. Patients with inoperable gastric cancer were randomly assigned to receive oral lansoprazole (30 mg) or placebo daily. The primary endpoint was the occurrence of tumor bleeding, and the secondary endpoints were transfusion requirement and overall survival (OS). Results: This study initially planned to enroll 394 patients, but prematurely ended due to low recruitment rate. Overall, 127 patients were included in the analyses: 64 in the lansoprazole group and 63 in the placebo group. During the median follow-up of 6.4 months, tumor bleeding rates were 7.8% and 9.5%, in the lansoprazole and placebo groups, respectively, with the cumulative bleeding incidence not statistically different between the groups (P=0.515, Gray's test). However, during the initial 4 months, 4 placebo-treated patients developed tumor bleeding, whereas there were no bleeding events in the lansoprazole-treated patients (P=0.041, Gray's test). There was no difference in the proportion of patients who required transfusion between the groups. The OS between the lansoprazole (11.7 months) and the placebo (11.0 months) groups was not statistically different (P=0.610). Study drug-related serious adverse event or bleeding-related death did not occur. Conclusions: Treating patients with inoperable gastric cancer with lansoprazole did not significantly reduce the incidence of tumor bleeding. However, further studies are needed to evaluate whether lansoprazole can prevent tumor bleeding during earlier phases of chemotherapy (ClinicalTrial.gov, identifier No. NCT02150447).

• Journal of Gastric Cancer
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• 제4권1호
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• pp.7-14
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• 2004

Purpose: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. Materials and Methods: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was $15.3\pm15.5$ ($1\∼56$) months. Results: In 15 patients with distant metastasis, 2 ($13.3\%$) showed complete response (CR), 10 ($66.7\%$) partial response (PR), 2 ($13.3\%$) stable disease (SD), and 1 ($6.7\%$) progressive disease (PD). The clinical response rate was $80.0\%$ Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. Conclusion: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.

• Journal of Gastric Cancer
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• 제8권1호
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• pp.40-46
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• 2008

목적: 재발했거나 수술이 불가능한 진행성 위암 환자에 있어서 FOIFOX 항암치료의 반응성 및 독성에 대한 초기경험을 조사, 정리하고자 하였다. 대상 및 방법: 2006년 4월부터 2007년 8월까지 근치적 위암 절제술 후 재발한 환자 35명과 수술 불가능한 위암으로 처음 진단된 환자 43명을 대상으로 modified FOIFOX-6 항암 치료를 진행하였으며, 그 결과를 후향적으로 분석하였다. 결과: 총 78명의 환자를 대상으로 평균 7.1회의 항암치료를 시행하였으며 RECIST 기준에 의한 부분 관해가 11명(14.1%)의 환자에서 관찰되었으며 안정 상태는 35명(44.9%)이었고 진행성 병변은 32명(44%)이었다. 진행성 병변이 나타나는데 걸리는 시간의 중앙값은 6개월이었으며 생존기간의 평균값은 13개월이었다. 독성 평가에서 1, 2등급의 빈혈이 가장 많은 41명의 환자에서 나타났으며 1, 2등급의 혈소판 감소증은 14명의 환자에서 나타났고 20명의 환자에서 1, 2등급의 말초신경독성을 보였다. 13명의 환자에서 진행성 병변에 의해 FOIFOX에서 S1-cisplatin으로 항암제의 교체가 있었으나 평균 1.76회 밖에 진행할 수 없었다. 결론: 59%의 환자에서 안정 상태 이상의 반응을 보였으며 어떠한 3, 4등급의 독성반응도 관찰되지 않았으므로, 수술 불가능하거나 재발한 위암 환자에서 FOLFOX 항암치료는 비교적 무난한 독성과 유리한 생존을 보이는 적절한 1차적 약제 선택으로 생각된다.

• Journal of Digestive Cancer Research
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• 제6권1호
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• pp.16-24
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• 2018

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.

• Journal of Gastric Cancer
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• 제18권1호
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• pp.1-19
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• 2018

Gastric cancer (GC) is the second leading cause of cancer mortality and the fourth most commonly diagnosed malignant diseases. While continued efforts have been focused on GC treatment, the introduction of trastuzumab marked the beginning of a new era of target-specific treatments. Considering the diversity of mutations in GC, satisfactory results obtained from various target-specific therapies were expected, yet most of them were unsuccessful in controlled clinical trials. There are several possible reasons underlying the failures, including the absence of patient selection depending on validated predictive biomarkers, the inappropriate combination of drugs, and tumor heterogeneity. In contrast to targeted agents, immuno-oncologic agents are designed to regulate and boost immunity, are not target-specific, and may overcome tumor heterogeneity. With the successful establishment of predictive biomarkers, including Epstein-Barr virus pattern, microsatellite instability status, and programmed death-ligand 1 (PD-L1) expression, as well as ideal combination regimens, a new frontier in the immuno-oncology of GC treatment is on the horizon. Since the field of immuno-oncology has witnessed innovative, practice-changing successes in other cancer types, several trials on GC are ongoing. Among immuno-oncologic therapies, immune checkpoint inhibitors are the mainstay of clinical trials performed on GC. In this article, we review target-specific agents currently used in clinics or are undergoing clinical trials, and highlight the future clinical application of immuno-oncologic agents in inoperable GC.

• Journal of Gastric Cancer
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• 제5권1호
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• pp.57-64
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• 2005

위암의 치료에 있어서 근치적 절제는 완치를 위한 유일한 방법이나 불행이도 많은 환자들이 국소적이나 혹은 타 장기로 전이된 상태로 발견된다. 이런 경우에는 근치적 절제술의 시행이 매우 어렵고 선행 화학요법을 시행하여 병기를 낮추려는 시도가 고려되어야 한다. Docetaxel은 반합성 택산으로 튜불린의 중합 반응을 유도하고 미세관의 해중합 반을을 방해함으로서 그 작용을 나타낸다. 현재 전이성 위암의 신행화학요법에서 docetaxel의 사용이 많이 시도되고 있고 그 반응률이 보고되고 있다. 본 교실에서는 docetsxel과 cisplatin 병용요법을 시행하여 전이성 위암의 부분 관해로 근치적 절제가 가응하였던 2예를 보고하는 바이다.

• Journal of Gastric Cancer
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• 제3권3호
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• pp.122-127
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• 2003

Purpose: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn't duplicate the result. the purpose of this study was to evaluate the relative efficacy & toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. Materials and Methods: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/$m^{2}$ IV for $1\∼5 days$), adriamycin (20 mg/$m^{2}$ IV for $1\∼5 days$) and cisplatin (20 mg/$m^{2}$ IV for $1\∼5 days$) and Twenty-eight patients receieved ELF chemotherapy : etoposide (100 mg/$m^{2}$ IV for $1\∼3 days$), leucovorin (20 mg/$m^{2}$ IV for $1\∼5 days$) and 5-FU (500 mg/$m^{2}$ IV for $1\∼5 days$). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient..ELF means 4.1 cycles per patient Results: Total respones rates were $5.4\%$ in the ELF group and $3.6\%$ in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value<0.05), and themedian overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis & hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: $27.6\%$ in ELF vs $54\%$ in EAP-II; Leukopenia: $8.5\%$ in ELF vs $19\%$ in EAP-II; nausea & vomiting: $45.9\%$ in ELF vs $67.8\%$ in EAP-II. Conclusion: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer (J Korean Gastric Cancer Assoc 2003;3:122-127)

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.945-950
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• 2014

Purpose: To explore the value of systemic inflammatory markers as independent prognostic factors and the extent these markers improve prognostic classification for patients with inoperable advanced or metastatic gastric cancer (GC) receiving palliative chemotherapy. Methods: We studied the prognostic value of systemic inflammatory factors such as circulating white blood cell count and its components as well as that combined to form inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384 patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy. Univariate and multivariate analyses were performed to examine the impact of inflammatory markers on overall survival (OS). Results: Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count, a decreased lymphocyte count, a low serum albumin concentration, and high CRP concentration, as well as elevated NLR/PLR, GPS, PI, PNI were significant predictors of shorter OS. Multivariate analysis demonstrated that only elevated neutrophil count (HR 3.696, p=0.003) and higher GPS (HR 1.621, p=0.01) were independent predictors of poor OS. Conclusion: This study demonstrated elevated pretreatment neutrophil count and high GPS to be independent predictors of shorter OS in inoperable advanced or metastatic GC patients treated with first-line chemotherapy. Upon validation of these data in independent studies, stratification of patients using these markers in future clinical trials is recommended.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.219-224
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• 2004

목적: 활발히 운영되고 있는 위암관련 인터넷 홈페이지에서 이루어진 질의와 설문 조사를 통해 위암환자나 보호자들의 위암에 관한 정보 욕구와 관심사항을 조사하였다. 대상 및 방법: 2002년 6월부터 2003년 9월까지 인터넷 홈페이지(www.gastriccancer.co,kr)에 문의된 619예의 질의와 2003년 8월부터 2003년 10월까지 시행된 설문에 응답한 524예의 위암 환자나 보호자들의 답변을 토대로 분석하였다. 결과: 질의 분석 619예의 질의를 내용에 따라 빈도순으로 분류해 보면 치료, 예후, 병기, 증상, 병태, 진단방법, 위암에 이로운 음식, 위암의 원인, 추적관리, 기타의 순이다. 치료에 관련된 질의 가운데 가장 높은 빈도는 수술 전후의 합병증이나 음식에 대한 내용이었고, 다음으로 항암 치료에 관련된 내용이 많았다. 수술 전 상황에서는 수술의 가능성과 예후에 관한 질문이 많았고, 수술 후 상황에서는 가능한 합병증과 예후에 관한 질문이 많았다. 수술이 불가능한 경우나 재발 위암의 경우에는 말기치료나 항암치료에 대한 질문이 많았다. 설문 분석 위암 관련 정보의 습득경로는 인터넷을 통한다는 답변이 가장 많았다. 의사들의 설명에 만족하는 경우는 $6\%$에 불과하였고, 설문 응답자의 $89.9\%$는 민간요법이나 대체요법에 대해 관심을 나타내었으며 단지 $5\%$만이 관심이 없다고 응답하였다. 결론: 위암 환자와 가족들은 위암에 관련된 정보의 습득을 갈망하고 있으나 의사들의 설명은 부족하다고 느끼고 있다. 발달된 인터넷 통신매체를 통한 올바른 위암 관련 의료정보를 제공함으로써 환자들의 치료와 건강증진에 도움을 줄 필요가 있다.

• Journal of Digestive Cancer Research
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• 제5권2호
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• pp.113-119
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• 2017

Background: Second line chemotherapy is often considered in advanced gastric cancers. We assessed irinotecan in combination with fluorouracil in patients experienced diseases progression after first line chemotherapy. Methods: Prospective trial was done at 7 centers in republic of Korea. Patients aged 18 years or older with advanced gastric adenocarcinoma and disease progression on or within 4 months after first-line chemotherapy were assigned to receive irinotecan 180 mg/m² and 5-fluorouraicl 400 mg/m² intravenously bolus injection on days 1 and leucovorin 200 mg/m² for 2 hours and 5-fluorouracil 600 mg/m² for 22 hours intravenously infusion on day 2 of a 14-day cycle (FOLFIRI group). The primary endpoint was objective tumor response (OR). Efficacy analysis was by per-protocol, and safety analysis included all patients who received at least one treatment with study drug. Results: Between January 1, 2014 and December 31, 2016, 28 patients were assigned to FOLFIRI treatment. Of those 20 patients were completed the study protocol. Per-protocol analysis, two patients among 20 subjects (10.0%) showed partial response. Overall survivals of FOLFIRI group; median 10.1 months [95% CI 4.9-15.3] Grade 3 and higher adverse event that occurred about 5%, but grade 3 or higher febrile neutropenia or life threatening complication was not reported. Conclusion: Combination chemotherapy with irinotecan, 5-FU, and LV is feasible in gastric cancer patients previously treated with platinum-based chemotherapy