Treatments options in detail
Standard Treatment Options for Gastric Cancer
The treatment of gastric cancer typically depends on the stage of the disease, the patient's overall health, and their preferences. The most common treatments include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.
Surgery
Surgery is often the first line of treatment for gastric cancer, especially if diagnosed at an early stage. Procedures may include subtotal gastrectomy, where part of the stomach is removed, or total gastrectomy, where the entire stomach is removed. Lymph nodes around the stomach may also be removed to check for the spread of cancer.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells and is commonly used before surgery (neoadjuvant chemotherapy) to shrink tumors, making them easier to remove, or after surgery (adjuvant chemotherapy) to kill any remaining cancer cells. Chemotherapy can also be used for advanced gastric cancer to relieve symptoms and extend life. Drugs such as fluorouracil, capecitabine, oxaliplatin, and cisplatin are commonly used.
Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. It may be used before surgery to shrink tumors or after surgery to destroy any remaining cancer cells. It can also be combined with chemotherapy (chemoradiation).
Targeted Therapy
Targeted therapy drugs act on specific molecular targets associated with cancer and can be used for advanced or metastatic gastric cancer. Trastuzumab is one such drug used for HER2-positive gastric cancer.
Immunotherapy
Immunotherapy helps the body's immune system fight cancer. Pembrolizumab (Keytruda) is an immunotherapy drug approved for advanced gastric cancer with certain characteristics, such as high levels of PD-L1 expression or mismatch repair deficiency (dMMR).
Opdivo (Nivolumab)
Opdivo is an immunotherapy drug approved for the treatment of advanced gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma in patients who have previously received two or more types of chemotherapy. It is a PD-1 inhibitor that helps the immune system recognize and attack cancer cells.
Keytruda (Pembrolizumab)
Keytruda is another PD-1 inhibitor used in the treatment of PD-L1 positive advanced gastric or gastroesophageal junction cancer. It is usually given to patients who have already received other cancer treatments.
Cyramza (Ramucirumab)
Cyramza is a vascular endothelial growth factor receptor 2 (VEGFR2) antagonist used as a single agent or in combination with chemotherapy for advanced gastric or gastroesophageal junction adenocarcinoma after prior chemotherapy. It works by inhibiting the blood supply to tumors, which can slow their growth.
Qinlock (Ripretinib)
Qinlock is a kinase inhibitor approved for the treatment of advanced gastrointestinal stromal tumors (GIST), a type of tumor that can occur in the stomach. It is used in patients who have received prior treatment with 3 or more kinase inhibitors, including imatinib.
Enhertu (Fam-trastuzumab deruxtecan-nxki)
Enhertu is a HER2-directed antibody and topoisomerase inhibitor conjugate approved for the treatment of adult patients with unresectable or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma who have received a prior trastuzumab-based regimen.
Experimental and Off-Label Treatments
Experimental treatments for gastric cancer are typically available through clinical trials. These may include new chemotherapy drugs, targeted therapies, immunotherapies, or combinations of existing treatments. Patients interested in experimental treatments should consult with their healthcare provider and consider enrolling in a clinical trial.
Off-label drug use involves prescribing drugs for an unapproved indication or in an unapproved age group, dosage, or route of administration. Physicians may consider off-label use of medications based on their clinical judgment, published literature, and individual patient circumstances.
Jeselhy (Pimitespib)
Jeselhy, also known as pimitespib, is an experimental heat shock protein 90 (HSP90) inhibitor currently being investigated in clinical trials for the treatment of gastric cancer. As an investigational drug, it is not approved by the FDA for any indication at this time.
Conclusion
Treatment options for gastric cancer are diverse and can be tailored to the individual's disease characteristics and personal health. Standard treatments are the backbone of therapy, while drugs like Opdivo, Keytruda, Cyramza, Qinlock, and Enhertu represent newer advances in the field. Experimental treatments, such as Jeselhy, offer hope for future advancements but are not yet approved for general use. Patients should discuss all available treatment options, including experimental and off-label use, with their healthcare provider to determine the best course of action for their specific situation.
