Anmerkungen:
Hinweis: Link zur Erstveröffentlichung URL: https://doi.org/10.1159/000503428
Beschreibung:
Background: Adenocarcinoma of the stomach and esophagogastric
junction (EGJ) remains a tumor entity with a poor
prognosis. While meaningful advances have been made in
the treatment of other solid tumors in the past years, numerous
phase III studies in gastric cancer have had negative outcomes.
Successes of targeted therapies so far include the
introduction
of trastuzumab in the first-line treatment of
HER2-positive gastric cancer, and second-line anti-angiogenic
treatment with the anti-VEGF-2 receptor antibody
ramucirumab. Taxanes have become established in the perioperative
setting and in second-line treatment and have set
new standards. However, evidence for improved overall survival
in the first-line treatment of advanced gastric cancer
with taxanes is not convincing. Methodology: Expert consensus
discussion on the scientific and clinical evidence for
sequential systemic treatment for advanced gastric and EGJ
cancer, taking into account data clinical outcomes from randomized
controlled phase II and phase III trials. Summary: In
first-line treatment of advanced gastric cancer, taxanes in
combination with a platinum- and 5-fluorouracil-based regimen
are generally not recommended because they lack a
survival benefit and confer high toxicity. However, taxanes
in first-line can be a treatment option for patients presenting
with high tumor burden and strong pressure to achieve remission.
Since the publication of several positive studies in
second- and third-line therapy, sequential therapy is playing
an increasingly important role in metastatic gastric and EGJ
cancer. Key Message: Standard of care for the first-line treatment
of gastric cancer is a platinum-fluoropyrimidine chemotherapy
doublet combination. The standard of care after
failure of platinum-based first-line therapy is ramucirumab
in combination with paclitaxel. Data supporting this combination
after previous taxane therapy are not yet available.