Multidisciplinary management of gastric cancer

Purpose of review The treatment of gastric cancer has been rapidly evolving with the emergence of new cytotoxic drugs and targeted biologic agents. The purpose of this review is to provide an update in the treatment of localized and metastatic gastric cancer. Recent findings Although the overall incidence of gastric cancer has been declining in the United States, the disease continues to be a devastating problem worldwide. Complete surgical resection offers the chance of cure for localized gastric cancer. However, local and distant recurrences are common. Adjuvant chemoradiation with 5-fluorouracil/leucovorin significantly improves disease-free survival and overall survival as demonstrated by the US Intergroup INT-116 study. Most recently, the UK Medical Research Council Adjuvant Gastric trial showed survival benefit with perioperative chemotherapy. Preoperative chemotherapy and chemoradiation have also been explored in several small randomized studies with encouraging results. However, this approach needs to be further confirmed in a large randomized phase III study. Finally, novel molecular targeting agents have been incorporated into the multimodality treatment and shown promising response rate and progression-free survival. Summary Gastric cancer remains one of the most clinically challenging cancers among all gastrointestinal malignancies. Mutimodality approach clearly offers survival benefit over surgery alone. In the United States, preoperative chemoradiation or postoperative adjuvant chemoradiation is widely practiced in major centers.