RT Book, Section
A1 Murphy, Mariela Blum
A1 Elimova, Elena
A1 Abdelhakeem, Ahmed
A1 Ajani, Jaffer
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190835087
T1 Gastric, Gastroesophageal Junction, and Esophageal Cancers
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK hemonc.mhmedical.com/content.aspx?aid=1190835087
RD 2024/04/18
AB KEY  CONCEPTSGastric  cancer  remains  the  third  most  common  cause  of  cancer-related  death  worldwide.Two  different  pathogeneses  of  gastric  cancer  have  been  proposed,  correlating  to  two  histologic  types:  intestinal  and  diffuse.Gastrectomy  is  the  recommended  treatment  in  relatively  early  localized  gastric  cancer  (T1b);  however,  in  more  advanced  gastric  cancers  (T2N0,  T1aN+,  or  T1b-T3N+),  adjunctive  therapy  in  addition  to  gastrectomy  is  recommended.The  results  of  INT-0116  study  (adjuvant  chemoradiation)  and  Medical  Research  Council  ST02/MAGIC  and  the  FLOT  study  (perioperative  chemotherapy)  have  shaped  the  current  practice  of  resectable  gastric  cancer  treatment  in  Western  countries.In  Asia,  postoperative  chemotherapy  has  been  considered  standard  after  gastrectomy  with  D2  dissection.  In  addition  to  the  ACTS-GC  trial  and  CLASSIC  trial  (S-1  for  1  year  and  CAPOX  for  6  months,  respectively),  two  new  regimens  (DS  and  SOX  for  6  months)  are  established  standards  of  care  for  stage  II  and/r  LN-positive  gastric  cancer.Only  30%  to  40%  of  patients  with  esophageal  cancer  have  potentially  resectable  disease  at  presentation,  and  in  many  series,  only  5%  to  20%  of  those  undergoing  surgery  alone  for  clinically  localized  disease  are  alive  at  3  to  5  years.Endoscopic  therapy  is  most  effective  when  used  to  treat  small  (<2  cm  diameter),  solitary,  flat  lesions  that  are  confined  to  mucosa  (T1a).Surgery  remains  the  best  chance  for  durable  survival  for  patients  with  locally  advanced  esophageal  and  gastroesophageal  junction  (GEJ)  cancers.Results  of  the  CROSS  trial  also  emphasized  the  beneficial  role  of  chemoradiotherapy  before  surgery,  which  led  to  a  significant  increase  in  overall  survival  (OS)  irrespective  of  tumor  histology.More  than  60%  of  patients  who  present  with  newly  diagnosed  gastric,  GEJ,  and  esophageal  cancers  will  have  advanced  unresectable  or  metastatic  disease.  Although  a  cure  is  not  possible,  systemic  therapy  can  prolong  survival  compared  with  best  supportive  care.As  of  this  writing,  patients  in  the  United  States  are  likely  to  undergo  frontline  therapy  with  platinum-,  fluoropyrimidine-,  or  taxane-based  chemotherapy  regimens,  with  the  addition  of  trastuzumab  in  patients  with  HER2-positive  disease.Based  on  positive  results  from  the  RAINBOW  trial,  paclitaxel  and  ramucirumab  (vascular  endothelial  growth  factor  receptor–2  targeted  drug)  is  considered  to  be  a  standard  for  second-line  treatment.  Ramucirumab  monotherapy  is  also  considered  a  second-line  option  in  advanced  gastric  cancer.Pembrolizumab  is  currently  approved  for  the  treatment  of  metastatic  squamous  cell  carcinoma  (SCC)  of  the  esophagus  as  second-line  treatment  for  tumors  with  combined  positive  score  (CPS)  more  than  10  and  programmed  cell  death  protein  1  (PD-L1)–positive  advanced  gastric  cancer  as  third-line  treatment  in  the  US.  Nivolumab  is  also  approved  in  the  US  for  metastatic  SCC  of  the  esophagus  regardless  of  PD-L1  expression,  and  in  Japan,  South  Korea,  and  Taiwan  for  the  treatment  of  gastric  cancer.The  Cancer  Genome  Atlas  analysis  has  uncovered  four  genotypes  of  gastric  cancer;  however,  it  is  not  sufficient  to  change  our  treatment  strategies,  and  additional  work  is  needed.A  multimodality  approach  to  therapy  will  be  the  cornerstone  to  screening,  diagnosing,  staging,  treating,  and  supporting  patients  with  upper  gastrointestinal  cancers.