Medical treatment of metastatic gastric cancer

Purpose: To identify chemotherapy regimens able to determine an high response rate and increase time to progression in metastatic gastric cancer patients. Materials and methods: We reviewed the literature about chemotherapy regimens with Oxaliplatin (O), Capecitabine (X) or Docetaxel (D), with a special interest to Trastuzumab (T) in HER-2 positive metastatic disease (ToGA Trial). Results: Recent studies have demonstrated same efficacy for X as a substitute for 5-Fluorouracil (F) and O compared to Cisplatin (C). The regimen containing anthracyclines (EOX) showed a high response rate (RR) with a reasonable toxicity and it is currently one of the gold standard regimens. The addition of D to the CF regimen determines an higher RR and time to progression (TTP), but it also causes an higher hematologic toxicity. On the whole, the DOX regimen could represent a valid combination for first line chemotherapy. A phase III study has shown an increase in overall survival (OS), progression free survival (PFS) and RR in patients with HER-2 positive disease treated with T in combination with chemotherapy (CF). Conclusion: The results from different studies show the same efficacy using O instead of C and X instead of F, with a lighter toxicity. The addition of Docetaxel to this regimen (DOX) could represent an efficient choice. After the results of the ToGA trial, the overexpression of HER-2 must be evaluated in order to give the best treatment to the patient. Eur. J. Oncol., 17 (2), 65-70, 2012