The West Clinic

Stage IV Gastric Cancer

Overview

Patients with stage IV gastric cancer have cancer that has spread to distant sites.

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 stage IV 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.

Optimal treatment for some patients with stage IV gastric cancer often requires more than one therapeutic approach. Thus, 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.

Surgery

For patients with Stage IV gastric cancer, surgery may be performed in order to reduce bleeding or to keep the cancer from obstructing the intestines or stomach. To learn more about surgical treatment, go to Surgery and Gastric Cancer.

Chemotherapy

Chemotherapy can relieve symptoms and extend survival among patients with advanced gastric cancer. Several chemotherapy regimens are available, and the choice of which to use depends in part on the patient’s health. Chemotherapy may be used in combination with other treatments such as targeted therapy, radiation therapy, and/or surgery.

Targeted Therapy

Targeted therapies are drugs that interfere with specific pathways involved in the growth or spread of cancer. In the case of some gastric cancers, a protein known as HER2 (human epidermal growth factor receptor 2) contributes to cancer growth. Metastatic gastric cancers that test positive for HER2 may be treated with a HER2-targeting drug called Herceptin® (trastuzumab). Herceptin is often used in combination with chemotherapy, and can prolong survival with advanced, HER2-positive gastric cancer.

Radiation Therapy

Radiation therapy involves the use of a particular type of energy, known as ionizing radiation, to kill cancer cells. Radiation can play a role in managing the symptoms of advanced gastric cancer, and can also help to control problems such as bleeding or blockages.

Strategies to Improve Treatment

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician.

Experimental drugs or treatments generally pass through three phases of clinical trials before they are considered for approval. Phase I clinical trials test an experimental drug or treatment for the first time in a small group of people to evaluate its safety, determine safe dosages, and identify side effects. Phase II clinical trials evaluate a new drug or treatment (or new combinations of treatments) in a larger group of people in order to assess effectiveness and further evaluate safety. Phase III clinical trials enroll a still larger number of people in order to confirm effectiveness and safety and to compare the new drug or treatment with standard treatments. If the new drug or treatment is then approved, additional studies (referred to as Phase IV or post-marketing studies) are conducted in order to monitor safety and effectiveness and refine the use of the new drug or treatment.

Areas of active investigation in clinical trials of advanced gastric cancer include the following:

New targeted therapies: Several targeted therapies are being evaluated for the treatment of advanced gastric cancer. These targeted therapies include additional HER2-targeted drugs such as Tykerb® (lapatinib); other types of targeted therapies that have already been approved for other purposes, such as Avastin® (bevacizumab) and Afinitor® (everolimus); and new drugs that are being evaluated in several types of cancer.

New approaches to chemotherapy: Researchers continue to evaluate new chemotherapy drugs and new combinations of chemotherapy. Some research is also investigating different ways of delivering chemotherapy; intraperitoneal chemotherapy, for example, delivers chemotherapy directly into the abdominal cavity.

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 Managing Side Effects.

Reference:

Bang Y-J, Van Cutsem E, Feyereislova A et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010; 376:687-697.

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