Gastric cancer: a comprehensive review of current and future treatment strategies
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NON-THEMATIC REVIEW
Gastric cancer: a comprehensive review of current and future treatment strategies Rachel E. Sexton 1 & Mohammed Najeeb Al Hallak 1 & Maria Diab 1 & Asfar S. Azmi 1 Received: 24 June 2020 / Accepted: 12 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Gastric cancer remains a major unmet clinical problem with over 1 million new cases worldwide. It is the fourth most commonly occurring cancer in men and the seventh most commonly occurring cancer in women. A major fraction of gastric cancer has been linked to variety of pathogenic infections including but not limited to Helicobacter pylori (H. pylori) or Epstein Barr virus (EBV). Strategies are being pursued to prevent gastric cancer development such as H. pylori eradication, which has helped to prevent significant proportion of gastric cancer. Today, treatments have helped to manage this disease and the 5-year survival for stage IA and IB tumors treated with surgery are between 60 and 80%. However, patients with stage III tumors undergoing surgery have a dismal 5-year survival rate between 18 and 50% depending on the dataset. These figures indicate the need for more effective molecularly driven treatment strategies. This review discusses the molecular profile of gastric tumors, the success, and challenges with available therapeutic targets along with newer biomarkers and emerging targets. Keywords Gastric cancer . Gastric adenocarcinoma . Non coding RNAs . lncRNA . Piwi RNA . Autophagy . Novel targets
1 Background Gastric cancer is a deadly disease with poor overall survival statistics throughout the world. The majority of new diagnoses per year of gastric cancer occur mainly in Asian and South American countries [1]. Within the USA, there are a projected 27,000 new cases to be diagnosed in 2020 [2]. It is only recently that researchers started to understand how heterogenous gastric cancer actually is. There are three major subtypes of gastric cancer, according to the Lauren Classification system, and four subtypes according to the WHO classification system [3, 4]. The Lauren classification system was developed in the 1960s and utilizes structural cellular components of the disease to separate patients into three subtypes: well differentiated (non-cardia/intestinal), poorly differentiated (cardia/diffuse), and mixed disease [3]. The Lauren classification has been classified further to include the addition of a new subtype, solid gastric cancer, and including the addition of
* Asfar S. Azmi [email protected] 1
Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, HWCRC 732, Detroit, MI 48201, USA
molecular markers in diagnosis criteria such as HER2 status [5, 6]. The other major classification system used is the World Health Organization (WHO) system, which elaborates further on the Lauren criteria [4]. The WHO subtypes include the papillary, tubular, signet ring, and mucinous [4]. Throughout the world, including the USA, the Lauren classification i
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