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Results of the REGATTA trial on surgical therapy of limited metastatic gastric cancer : open issues and future perspectives
| Content Provider | Semantic Scholar |
|---|---|
| Author | Conradi, Lena-Christin Lordick, Florian |
| Copyright Year | 2016 |
| Abstract | Transl Cancer Res 2016;5(S2):S178-S181 tcr.amegroups.com Gastric cancer (GC) is the third leading cause of cancerrelated death worldwide (723,000 deaths, 8.8% of cancer associated mortality), with regional, etiological differences and the highest prevalence in Asia (1-3). In Western countries most of the patients are diagnosed in advanced stages (up to 80% stage IV) as the cancer remains often asymptomatic or presents with unspecific symptoms (4). Patients with stage III and IV GC have a poor prognosis with 5-year overall survival (OS) rates of 9.2–19.8% and 4.0%, respectively. Treatment in these stages is mainly in palliative intent (5). However, in Eastern countries active screening programs proved to be beneficial and higher percentages of patients are diagnosed in early stages, when treatment can be curative (6). The current standard therapy for early GC is gastrectomy and DII-lymphadenectomy, whereas locally advanced stages require a multimodality treatment approach including surgery combined with perioperative chemotherapy or chemo-radiotherapy (CRT) (5). The cornerstone of the treatment of advanced/ metastatic GC remains chemotherapy; in addition, combinational strategies or monotherapy with targeted therapies against Her2 (ERBB2) or VEGFR2 (KDR) were recently introduced and proved to prolong OS (2,7,8). Furthermore molecular analysis of GC has led to new molecularly based GC classifications based on mutation status, gene copy-number changes, gene expression, and DNA methylation data (9,10). Of note, patient stratification to targeted agents or combinational therapies based on molecular signatures will become important as new therapies like immunotherapy evolve but only subgroups of patients benefit from these novel treatment approaches. The prevalence of Her2 overexpression is only about 10% to 25% (11,12); thus, in the majority of patients chemotherapy and inhibition of angiogenesis or maybe in the future immunotherapeutic approaches are their only options. Therefore, identification of predictive biomarkers for patients’ stratification is of utmost importance and should be the aim of future upcoming trials combining molecular testing and targeted therapy approaches. Advanced stage GC patients experience often side effects from the local tumor growth. Major complications are bleeding, gastrointestinal obstruction or perforation (5). Therefore, palliative surgical approaches such as gastric resection and other non-resectional procedures for stage IV disease have been controversially discussed over the last years (5,13). Gastric resection or non-resectional approaches (e.g., gastric bypass) improved dramatically over time due to advances in periand postoperative management of patients and also improvements in patient selection (14). Another open question is the value of metastatic resection in very limited metastatic disease. Improvements of oncological therapies and close interdisciplinary collaboration led in the recent years to an extension of surgical indications for metastatic disease in different entities. Currently, for esophageal and GC there is still an ongoing discussion on broadening of surgical indications. Mönig et al. emphasize the need to reevaluate the value of surgical resection in the frame of multimodal therapeutic strategies even though the recent guidelines do not recommend surgery for local metastatic GC (15). Overall, different retrospective trials support the hypothesis that certain subgroups may benefit from surgical treatment Editorial |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://tcr.amegroups.com/article/viewFile/8752/pdf |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Antivirus software Biological Markers Cathode ray tube Cessation of life Cheminformatics Chemotherapy Classification Combinational logic Combined Modality Therapy Dynamic Invocation Interface ERBB2 protein, human Eighty Entity Gastrectomy Gastric Bypass Gastrointestinal Hemorrhage Gene Expression Immunotherapy Lymph node excision Malignant neoplasm of stomach stage IV Medical Device Material Perforation Metastatic Neoplasm Molecular Analysis Multimodal Imaging Multimodal interaction Mutation Neoplasms Obstruction Operating system Overall Survival Patients Polyposis, Gastric Radiotherapy, Conformal Stand Up to Cancer Stomach Carcinoma Stratification Therapeutic procedure stage IV childhood Hodgkin's lymphoma |
| Content Type | Text |
| Resource Type | Article |
