Background: Gastric cancer is a leading cause of cancer-related deaths worldwide. Several treatment possibilities have been investigated, but only a few show clinically meaningful results. Summary: Systemic treatment options for advanced gastric cancer (aGC) have evolved over the recent years, implementing the growing molecular knowledge of this heterogeneous disease. Molecular profiling (at least for HER-2-expression, microsatellite instability status, Epstein-Barr virus expression, and programmed death ligand-1 expression/combined positive score [CPS]) is recommended for all therapy-fit patients prior to the start of a systemic treatment and is crucial for decisions on treatment strategy and drug selection. Various examples like the application of trastuzumab in the HER-2-positive subgroup underline the benefits of this approach starting from the first-line setting. A combination of platinum and fluoropyrimidine remains the first-line chemotherapy backbone in the treatment of advanced gastric cancer. Triplet combinations adding taxanes to the doublet regimen are reserved for certain scenarios. Unfortunately, almost all patients who receive first-line treatment (with or without anti-HER-2 blockade) progress and #x3c;70% are eligible for a second-line therapy. The addition of monoclonal antibodies has substantially improved outcomes in this setting. As such, ramucirumab has led to significant and clinically meaningful advancements in the second-line treatment. Furthermore, immuno-oncology with checkpoint inhibition and immune stimulation has evolved in the field of aGC. Recent first-line data show a significant survival benefit in aGC patients with a CPS ≥ 5 under immunochemotherapy. Nonetheless, the impact of immunotherapy combinations and immunochemotherapy remains an area of investigation. Key Message: In this review, we highlight recent improvements in the treatment landscape of advanced gastric cancer, the heterogeneity of this disease, and possible personalized targets.
Oncol Res Treat

中文翻译：

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晚期胃癌：当前的治疗格局以及序贯和个性化指南的未来展望：瑞士专家声明文章

背景：胃癌是全世界癌症相关死亡的主要原因。已经研究了几种治疗可能性，但只有少数显示出具有临床意义的结果。摘要：近年来，晚期胃癌 (aGC) 的系统治疗方案不断发展，体现了对这种异质性疾病不断增长的分子知识。建议在开始治疗之前对所有适合治疗的患者进行分子分析（至少针对 HER-2 表达、微卫星不稳定状态、 Epstein-Barr 病毒表达和程序性死亡配体 1 表达/组合阳性评分 [CPS]）系统治疗，对于治疗策略和药物选择的决策至关重要。曲妥珠单抗在 HER-2 阳性亚组中的应用等各种例子都强调了这种方法从一线开始的好处。铂和氟嘧啶的组合仍然是治疗晚期胃癌的一线化疗骨干。在双联方案中添加紫杉烷的三联组合保留用于某些情况。不幸的是，几乎所有接受一线治疗（有或没有抗 HER-2 阻断）的患者均取得进展，并且 #x3c;70% 有资格接受二线治疗。单克隆抗体的添加显着改善了这种情况下的结果。因此，雷莫芦单抗在二线治疗中取得了重大且具有临床意义的进展。此外，具有检查点抑制和免疫刺激的免疫肿瘤学在 aGC 领域得到了发展。最近的一线数据显示，CPS ≥ 5 的 aGC 患者在免疫化疗下具有显着的生存获益。尽管如此，免疫疗法组合和免疫化疗的影响仍然是一个研究领域。关键信息：在这篇综述中，我们强调了晚期胃癌治疗领域的最新进展、该疾病的异质性以及可能的个性化目标。
Oncol Res 治疗