Current treatment and recent progress in gastric cancer

Abstract

Gastric cancer is not a top-10 malignancy in the United States but represents one of the most common causes of cancer death worldwide. Biological differences between tumors from Eastern and Western countries add to the complexity of identifying standard-of-care therapy based on international trials. Systemic chemotherapy, radiotherapy, surgery, immunotherapy, and targeted therapy all have proven efficacy in gastric adenocarcinoma; therefore, multidisciplinary treatment is paramount to treatment selection. Triplet chemotherapy for resectable gastric cancer is now accepted and could represent a plateau of standard cytotoxic chemotherapy for localized disease. Classification of gastric cancer based on molecular subtypes is providing an opportunity for personalized therapy. Biomarkers, in particular microsatellite instability (MSI), programmed cell death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (HER2), tumor mutation burden, and Epstein-Barr virus, are increasingly driving systemic therapy approaches and allowing for the identification of populations most likely to benefit from immunotherapy and targeted therapy. Significant research opportunities remain for the less differentiated histologic subtypes of gastric adenocarcinoma and those without markers of immunotherapy activity.

Keywords: adenocarcinoma; gastric cancer; immunotherapy; molecular subtypes; stomach neoplasms.

Conflict of interest statement

Conflicts of Interest: None.

© 2021 American Cancer Society.

Figures

Figure 1.

Separation of the greater omentum from the transverse colon and mesocolon.

Figure 2.

Transection of the right gastroepiploic vessels and duodenum.

Figure 3.

Ligation and transection of the left gastric vessels

Figure 4.

Removal of distal portion of stomach in preparation for subtotal gastrectomy.

Figure 5.

Reconstruction after subtotal gastrectomy.

Figure 6.

Reconstruction after total gastrectomy.

Figure 7.

Illustration of D1 or regional lymph node dissection.

Figure 8.

Extra-regional, or D2, lymph node dissection.

Figure 9.

Branches of celiac trunk and D2 lymph node dissection.