Modern treatment of oesophageal cancer, gastroesophageal junction and stomach – 2017 update

Česká verzia

Authors: R. Obermannová
Authors place of work: Klinika komplexní onkologické péče, Masarykův onkologický ústav, Brno
Published in the journal: Gastroent Hepatol 2017; 71(5): 409-414
Category: Gastrointestinal Oncology: Review Article
doi: https://doi.org/10.14735/amgh2017409

Summary

Locally advanced and metastatic oesophagogastric cancer remains a leading cause of cancer-related death. Despite recent therapeutic advances, the overall survival of patients with metastatic disease is still poor, reaching about 12 months. Chemotherapy is a fundamental part of the perioperative approach but is also a part of concurrent component of preoperative or definitive radiotherapy in locally advanced disease as well. The FLOT (5-fluorouracil, oxaliplatin, docetaxel) regimen is the new standard for perioperative chemotherapy and implementation of this schedule has resulted in a 5-year overall survival rate of 45%. Radiotherapy is a crucial preoperative method for the treatment of oesophageal cancer and cancer of the oesophagogastric junction; however, the radiotherapy used in an adjuvant setting in gastric cancer is still challenging and should be defined by ongoing clinical trials. Trastuzumab, a monoclonal HER2 antibody, is a standard part of metastatic disease management and ramucirumab, an antiangiogenic antibody, is a part of second line treatment in cases of metastatic disease. Unfortunately, other targeted molecules have failed in clinical trials. With the development in the field of immunooncology, checkpoint inhibitors are also being investigated for the treatment of upper gastrointestinal malignancies. An overall response of around 20% has been achieved in early phase clinical trials. Palliative surgical methods are now part of the treatment armamentarium and have been used for comprehensive gastric cancer treatment. Metastasectomy and palliative gastric cancer resection remain experimental and their roles need to be defined.

Key words:
oesophagogastric cancer – chemotherapy – checkpoint inhibitors

The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
24.9.2017

Accepted:
27.9.2017

Zdroje

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