Maintenance treatment in advanced HER2-negative gastric cancer
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REVIEW ARTICLE
Maintenance treatment in advanced HER2‑negative gastric cancer Y. Yao1 · R. Deng1 · D. Liao1 · H. Xie1 · J. Zuo1 · Y. Jia1 · F. Kong1 Received: 16 April 2020 / Accepted: 9 May 2020 © Federación de Sociedades Españolas de Oncología (FESEO) 2020
Abstract Survival for patients with advanced gastric cancer (GC) remains poor. Systemic chemotherapy which has reached a plateau stays the standard first-line (1L) treatment for advanced human epidermal growth-factor receptor 2 (HER2)-negative GC. To maximize the benefit of 1L treatment, the concept of maintenance treatment is constantly being explored. In advanced HER2-negative GC, current clinical guidelines do not recommend a standard maintenance therapy strategy. In addition to the monotherapy maintenance with fluorouracil after 4–6 cycles of 1L chemotherapy, some agents that are active against novel targets have been evaluated in clinical trials for maintenance treatment. Whereas most of these trials do not reach their primary endpoints, they open new horizons for the 1L treatment of advanced HER2-negative GC. Therefore, we reviewed the clinical trials in the field of maintenance treatment in advanced HER2-negative GC and discussed some of the problems in clinical trials. Keywords Gastric cancer · Chemotherapy · Immunotherapy · Maintenance treatment
Introduction Gastric/gastroesophageal cancer (GC/GEC) is the fifth common malignancies and the third most common cause of cancer-related mortality worldwide. According to the American Cancer Society, in 2020, there will be approximately 27,600 new GC cases and 11,010 GC-related deaths in the United States [1, 2]. Due to the lack of specific symptoms at early stages, about 50% of cases are usually not diagnosed until an advanced stage. Patients with advanced disease (locally advanced or metastatic) have poor prognosis with median overall survival (OS) of less than 12 months [3, 4]. Over the past decade, the development of emerging therapies has changed the treatment pattern of advanced GC to some extent. HER2 was the first effective targeting to be found in GC. ToGA trial demonstrated that adding trastuzumab to 1L chemotherapy could increase the OS in patients with advanced HER2-positive GC to more than 1 years [5]. Based on this, in October 2010, the United States Food and Drug Administration (FDA) approved trastuzumab * F. Kong [email protected] 1
Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Anshanxi Road, Nankai District, Tianjin 300193, China
combined with chemotherapy for 1L treatment of advanced HER2-positive GC. Subsequently, several new drugs that targeting different pathways were also approved for different stages of GC. Ramucirumab was approved for the secondline (2L) treatment of advanced GC and apatinib for thirdline in China [6, 7]. Immune checkpoint inhibitors including nivolumab for chemotherapy-refractory GC in Japan and pembrolizumab for chemotherapy-refractory programmed death ligand 1 (PD-L1)-positive or microsatellite ins
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