Stage 4 stomach cancer
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Stage 4 Stomach Cancer: Current Insights and Treatment Approaches
Molecular Testing in Stage 4 Stomach Cancer
Importance of Molecular Profiling
Molecular profiling has become a critical component in the treatment of stage 4 stomach cancer. This approach helps identify specific biomarkers that can guide targeted therapies and immunotherapies, which are essential for improving patient outcomes. In a study conducted in India, molecular testing for human epidermal growth factor receptor 2 (HER2/neu), mismatch repair (MMR)/microsatellite instability (MSI), and programmed death ligand 1 (PDL-1) was performed on patients with stage 4 gastric/gastroesophageal junction adenocarcinoma. The results showed that 16.16% of patients were HER2/neu-positive and were subsequently treated with trastuzumab, a targeted therapy that has been shown to improve survival rates.
Prevalence of Biomarkers
The same study found that 8.8% of patients had deficient mismatch repair (d-MMR) or MSI-high status, with a subset of these patients benefiting from immune checkpoint inhibitors. Additionally, 32.7% of patients tested positive for PDL-1, indicating potential eligibility for immunotherapy. These findings underscore the importance of comprehensive molecular testing in the management of advanced gastric cancer.
Treatment Strategies for Advanced Gastric Cancer
Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy (NAC) has been explored as a treatment strategy for advanced gastric cancer, particularly for scirrhous-type and large type 3 gastric cancers. A phase III randomized controlled trial (JCOG0501) compared the efficacy of NAC with S-1 plus cisplatin followed by D2 gastrectomy and adjuvant chemotherapy to surgery followed by adjuvant chemotherapy alone. The study found no significant survival benefit from the addition of NAC, with 3-year overall survival rates of 60.9% in the NAC group compared to 62.4% in the surgery-only group .
Safety and Surgical Outcomes
Despite the lack of a survival benefit, the trial demonstrated that NAC could be safely administered without increasing morbidity or mortality. Major adverse events during NAC included neutropenia, nausea, diarrhea, and fatigue, but these were manageable. The operation time was also shorter in the NAC group, suggesting that NAC may facilitate easier surgical procedures.
Challenges in Early Diagnosis
Late-Stage Diagnosis in East Africa
A systematic review focusing on East African countries revealed that stomach cancer is often diagnosed at advanced stages, specifically stage III and IV. This late diagnosis significantly impacts clinical outcomes and overall survival rates. The review highlighted the need for early diagnosis, improved health facilities, and enhanced diagnostic modalities to improve patient outcomes in these regions.
Conclusion
Stage 4 stomach cancer remains a challenging condition to treat, but advancements in molecular profiling and targeted therapies offer hope for improved outcomes. While neoadjuvant chemotherapy has not shown a clear survival benefit, it remains a viable option for certain patient groups. Early diagnosis and improved healthcare infrastructure are crucial for better management of this disease, particularly in regions where late-stage diagnosis is prevalent.
Sources and full results
Most relevant research papers on this topic