Stage 4 gastric cancer
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Summary
5 papers analyzed
These studies suggest that while new chemotherapeutic strategies have improved survival rates for stage 4 gastric cancer, particularly in younger patients and those with proximal-GC, neoadjuvant chemotherapy with S-1 plus cisplatin has not shown a survival benefit for type 4 or large type 3 gastric cancer, and D2 surgery followed by adjuvant chemotherapy remains the standard treatment.
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Stage 4 Gastric Cancer: Treatment and Prognosis
Chemotherapy and Survival Rates in Stage 4 Gastric Cancer
Impact of New Chemotherapeutic Agents
The introduction of new chemotherapeutic agents has significantly improved the prognosis for patients with stage 4 gastric cancer. A comprehensive analysis of 35,751 gastric cancer cases from a population-based cancer registry in Japan, including 8,214 stage 4 cases, revealed that the overall survival rate for stage 4 patients improved from 11.4% to 13.2% following the approval of several oncologic drugs since 2009. This improvement was particularly notable among younger patients and those with proximal gastric cancer (PGC).
Neoadjuvant Chemotherapy for Advanced Gastric Cancer
Efficacy of S-1 Plus Cisplatin
A phase III randomized controlled trial (JCOG0501) evaluated the efficacy of neoadjuvant chemotherapy (NAC) with S-1 plus cisplatin for patients with type 4 or large type 3 gastric cancer. The study found no significant survival benefit for patients receiving NAC compared to those undergoing surgery followed by adjuvant chemotherapy with S-1. The 3-year overall survival rates were 62.4% for the surgery-only group and 60.9% for the NAC group, indicating that D2 surgery followed by adjuvant chemotherapy remains the standard treatment for these patients .
Comparison of Chemotherapy Regimens
A randomized phase II study is currently comparing two neoadjuvant chemotherapy regimens: 5-fluorouracil/oxaliplatin/docetaxel versus docetaxel/oxaliplatin/S-1 for patients with type 4 or large type 3 gastric cancer. The primary endpoint is the proportion of patients with a pathological response, with secondary endpoints including overall survival and adverse events. This study aims to identify a more effective chemotherapy regimen for this challenging patient population.
Adjuvant Chemotherapy Duration for Stage II Gastric Cancer
A phase III non-inferiority trial (JCOG1104 [OPAS-1]) investigated whether the duration of adjuvant chemotherapy with S-1 could be shortened from one year (eight courses) to six months (four courses) for patients with stage II gastric cancer. The study concluded that one year of S-1 remains the standard care, as the shorter duration did not meet the non-inferiority criteria and showed a lower relapse-free survival rate.
Conclusion
The prognosis for stage 4 gastric cancer has improved with the introduction of new chemotherapeutic agents, particularly benefiting younger patients and those with proximal gastric cancer. However, neoadjuvant chemotherapy with S-1 plus cisplatin has not demonstrated a survival advantage for type 4 or large type 3 gastric cancer, and one year of adjuvant S-1 remains the standard care for stage II gastric cancer. Ongoing research continues to seek more effective treatment regimens for advanced gastric cancer.
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