Perioperative chemotherapy is the standard of care for localized gastric cancer (GC). In 2018, additional postoperative radiotherapy was found to be ineffective; although, docetaxel was found to be superior to epirubicin in perioperative three-drug chemotherapy regimens. Validated biomarkers are needed for benefit from immunotherapy in advanced-stage GC. Metachronous GC can be prevented by Helicobacter pylori eradication.
Docetaxel should replace epirubicin in three-drug perioperative chemotherapy regimens for patients with localized gastric cancer4.
Immune-checkpoint inhibition has limited efficacy in patients with advanced-stage gastric cancer; further research exploring biomarkers to identify patient groups who are most likely to benefit is mandatory7.
Eradication of Helicobacter pylori infection reduces the risk of metachronous gastric cancer in patients with resected early stage gastric cancer and in those with high-grade adenoma10.
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Bray, F. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 68, 394–424 (2018).
Smyth, E. C. et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 27, v38–v49 (2016).
Cats, A. et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomized phase 3 trial. Lancet Oncol. 19, 616–628 (2018).
Al-Batran, S. E. et al. Peri-operative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin, and epirubicin for resectable gastric or gastro-esophageal junction cancer (FLOT4): a phase 2/3, open-label, randomized controlled trial. Lancet (in the press).
Tabernero, J. et al. Pertuzumab plus trastuzumab and chemotherapy for HER2-positive metastatic gastric or gastro-oesophageal junction cancer (JACOB): final analysis of a double-blind, randomised, placebo-controlled phase 3 study. Lancet Oncol. 19, 1372–1384 (2018).
Kang, Y. K. et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 390, 2461–2471 (2017).
Shitara, K. et al. Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061): a randomised, open-label, controlled, phase 3 trial. Lancet 392, 123–133 (2018).
Janjigian, Y. Y. et al. Genetic predictors of response to systemic therapy in esophagogastric cancer. Cancer Discov. 8, 49–58 (2018).
Kim, S. T. et al. Comprehensive molecular characterization of clinical responses to PD-1 inhibition in metastatic gastric cancer. Nat. Med. 24, 1449–1458 (2018).
Choi, I. J. et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N. Engl. J. Med. 378, 1085–1095 (2018).
F.L. has received honoraria for consulting or advisory roles, membership of a data safety board or lectures from Amgen, Astellas, AstraZeneca, Biontech, Bristol-Myers Squibb, Eli Lilly, Elsevier, Infomedica, Merck, MSD, Roche and Servier, and has received research support (institutional) from BMS. E.C.S. has received honoraria for consulting or advisory roles from BMS, Celgene, Five Prime Therapeutics, Gritstone Oncology and Servier.
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Lordick, F., Smyth, E.C. Two steps forward and one step back. Nat Rev Clin Oncol 16, 69–70 (2019). https://doi.org/10.1038/s41571-018-0154-4