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Overview

Patients with recurrent gastric cancer have cancer that has returned after primary treatment. Patients with refractory gastric cancer have cancer that has stopped responding to primary or secondary treatments.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of recurrent or refractory gastric cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Patients experiencing progression of gastric cancer have been perceived to have few treatment options. Certain patients, however, can derive meaningful benefit from additional treatment. It is important for patients to be treated at a medical center that can offer multi-modality treatment involving medical oncologists, radiation oncologists, surgeons, gastroenterologists and nutritionists.

Chemotherapy

Chemotherapy is the main treatment for patients who have residual cancer after surgery or experience a cancer recurrence after surgery. Single chemotherapy agents such as Platinol®, 5-FU, Mutamycin®, doxorubicin and Ellence® have been used for the treatment of gastric cancer for several years. However, these drugs result in clinical responses in less than half of patients with recurrent gastric cancer and virtually no complete responses are seen following single agent chemotherapy. The survival of patients treated with 5-FU-based chemotherapy combinations is less than one year. Recent clinical trials indicate that newer chemotherapy agents such as Camptosar®, Gemzar®, Taxotere® and paclitaxel may be the most active single agents for the treatment of gastric cancer, with complete disappearance of cancer occurring in up to 15% of patients. Current clinical trials are evaluating various combinations of these newer drugs often in combination with Platinol® and 5-FU.

Radiation Therapy With or Without Chemotherapy

Patients who experience a cancer recurrence following surgery can sometimes benefit from treatment with radiation therapy with or without chemotherapy. Radiation therapy can be extremely effective in temporarily controlling local symptoms from gastric cancer. In one clinical trial, 27 patients with inoperable gastric cancer were treated with chemotherapy and concurrent radiation therapy. The overall response rate was 56%, including 11% with a complete response. Two years following treatment, 29% of patients were alive without progression of their cancer. It was concluded from this clinical trial that combined chemotherapy and radiation therapy has substantial activity for the local control of advanced gastric cancer. Future clinical trials will continue to evaluate combinations of newer chemotherapy drugs and radiation with other local-regional and systemic treatments.

Nutritional Support

Prior to any surgical procedure, adequate preparation of the patient is important to minimize complications. Many patients with gastric cancer are malnourished at the time of diagnosis. Aggressive nutritional support has not been shown to improve long-term survival, but it has been shown to improve survival in the immediate post-operative period. Feeding intravenously and/or through a naso-gastric tube can enhance nutrition before surgery.

Strategies to Improve Treatment

The progress that has been made in the treatment of gastric cancer has resulted from the use of multi-modality treatment and improved patient and physician participation in clinical trials. Future progress in the treatment of gastric cancer will result from continued participation in appropriate trials. Currently, there are several areas of active exploration aimed at improving the treatment of gastric cancer.

Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Supportive Care.

New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials in patients with stage IV or recurrent gastric cancer.

Multiple Drug Resistance Inhibitors: Gastric cancer can be drug resistant at the outset of treatment or develop drug resistance after treatment. Several drugs are being tested to determine if they will overcome or prevent the development of multiple drug resistance in gastric and other cancers.

Phase I Trials of Chemotherapy: New chemotherapy drugs continue to be developed and evaluated in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and to determine whether the drug has any anti-cancer activity in patients with gastric cancer. Phase I trials are usually performed in patients with recurrent or refractory cancer.

Gene Therapy: Currently, there are no gene therapies approved for the treatment of gastric cancer. Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a dysfunction gene or replacing or adding a functional gene into a cell to make it function normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death or efforts to make the immune system kill cancer cells. A few gene therapy studies are being carried out in patients with refractory gastric cancer. If successful, these therapies could be applied to patients with earlier stage disease.