Stomach Cancer

Stomach Cancer

In the United States, about 21,000 people are diagnosed with stomach cancer annually, and 10,000 die of the disease. Worldwide, stomach cancer is much more common, in part because of high rates of infection with the bacterium H. Pylori, which was found in the 1990s to increase the risk of stomach cancer, ulcers, and other stomach problems.

Since the late 1980s, major research findings have improved options for patients with early stage disease. While full surgical removal of the stomach (gastrectomy) was previously the only option to potentially cure early stage stomach cancer, studies showed that a partial removal of the stomach was just as effective for many patients. Other research found significant improvement in long-term survival with the addition of adjuvant radiation and chemotherapy.

For patients with advanced disease, survival remains relatively low and effective new treatments are urgently needed. Through clinical trials, doctors continue to refine chemotherapy regimens in ways that extend patients' lives and significantly delay problems like loss of appetite and weight loss.
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2014

New targeted treatment helps people with advanced stomach cancer live longer

New targeted treatment helps people with advanced stomach cancer live longer

The FDA approves ramucirumab (Cyramza), for treatment of advanced cancers of the stomach and gastroesophageal junction. This marked the first FDA-approved treatment for patients with advanced stomach cancer that worsened during or after chemotherapy. The approval follows results from a clinical trial showing that ramucirumab both alone and combined with the chemotherapy paclitaxel (Abraxane) modestly extends patient survival. Anti-angiogenic drugs like ramucirumab block the growth of blood vessels to the tumors.

More Information: 

NCI; FDA Approval for Ramucirumab
Lancet 2014; 383(9911): 31–39
Lancet Oncology 2014; 15(14): 1224–1235
Chemotherapy extends survival after stomach cancer surgery

Chemotherapy extends survival after stomach cancer surgery

A large trial shows that patients with early stomach cancer who receive chemotherapy with capecitabine (Xeloda) and oxaliplatin (Eloxatin) after surgery live longer than those who have surgery alone. These results affirm that adjuvant (post-surgery) chemotherapy can make a vital difference for patients with stomach cancer, as it does for breast, colon, and several other cancers.   

More Information: 

Lancet Oncology 2014; 15(12): 1389-1396

2012

Adding radiation to chemotherapy after surgery still benefits some patients

Adding radiation to chemotherapy after surgery still benefits some patients

Building on the results of a 2011 Korean trial, a study suggests that for patients with stomach cancer that has spread to the lymph nodes, there is a small but significant improvement in survival from adding radiation to adjuvant (post-surgical) chemotherapy, in this case using the drugs capecitabine (Xeloda) and cisplatin. A larger trial is currently underway to confirm these results.

Because radiation only slightly improved outcomes, adjuvant chemotherapy alone after aggressive surgery also remains a viable treatment option for certain patients.

More Information: 

Journal of Clinical Oncology 2012; 30(3): 268-73

2011

Korean study affirms value of chemotherapy, alone, following surgery

2010

Common targeted breast cancer drug also improves survival for certain gastric cancers

2008

New chemotherapy regimen extends survival for metastatic gastric cancers

New chemotherapy regimen extends survival for metastatic gastric cancers

Chemotherapy with the drugs cisplatin or fluorouracil was used to shrink or stall the growth of tumors in patients with advanced gastric cancers, but results were inconsistent and treatment often caused significant side effects. In 2008, a large trial finds that adding oxaliplatin to fluorouracil and leucovorin chemotherapy shrinks tumors in many patients and generally causes fewer side effects than a regimen of cisplatin, fluorouracil and leucovorin. The newer regimen is particularly effective in older patients.

A later trial finds that replacing one part of this regimen – fluorouracil – with an oral version of the same drug, called capecitabine (Xeloda) is comparably effective. This alternative allows patients the freedom to receive more of their treatment outside of their doctor's office.

More Information: 

Journal of Clinical Oncology 2008; 26(9): 1435-42
Annals of Oncology 2009; 20(4): 666-73
Adjuvant chemotherapy alone, without radiation, may be sufficient for early gastric cancer

Adjuvant chemotherapy alone, without radiation, may be sufficient for early gastric cancer

A large Japanese trial suggests that surgery plus adjuvant (post-surgical) chemotherapy with the drug S-1 – without radiation – is an effective treatment option. Patients in the trial had outcomes comparable to those in past trials who were treated with another standard chemotherapy regimen, plus radiation, following surgery. Further research has shown that S1 tends to be safer and more effective in Asian patients, whose cancers tend to grow and respond to treatment differently than those of Western patients. While debate continues about the best adjuvant approach, in particular for patients who undergo more extensive surgery, this study suggests that patients may be able to forgo the added side effects of radiation without reducing their chances of long-term survival.

More Information: 

N Engl J Med 2007; 357: 1810-20

2006

New addition to chemotherapy improves survival for select patients
Chemotherapy before and after surgery improves survival for many patients

Chemotherapy before and after surgery improves survival for many patients

Results of the "MAGIC" trial provide one of the most significant advances against stomach cancer in many years, showing that chemotherapy both before and after surgery improves survival. This regimen soon becomes standard for patients with operable gastric cancer. The substantial benefit of chemotherapy leads investigators to question for the first time whether post-surgery radiation therapy is needed for patients with this form of gastric cancer.

More Information: 

N Engl J Med 2006; 355: 11-20

2005

Removal of additional lymph nodes shown to help improve survival

Removal of additional lymph nodes shown to help improve survival

While gastric cancer surgery had long involved removal of both the tumor and surrounding lymph nodes to prevent further spread, an open question was whether removing lymph nodes further away from the tumor – to find additional signs of cancer's spread and guide treatment decisions – could help improve survival.

In 1999, Dutch researchers initially report no survival benefit with more extensive lymph node surgery, a procedure known as D2 surgery, compared to removal of just the nearby lymph nodes (known as D1). However, longer follow-up from the same study ultimately reveals that the more extensive D2 dissection is in fact associated with fewer recurrences and gastric cancer-related deaths. Today, D2 resection is the global standard for gastric cancer surgery.

More Information: 

N Engl J Med 1995; 340(12): 908-14
N Engl J Med 2008; 359(5): 453-63
Lancet Oncology 2010; 11(5): 401-98

2001

Gene identified in inherited gastric cancer

Gene identified in inherited gastric cancer

Researchers first link a specific gene – the E-cadherin gene (CHD1) – to a type of hereditary gastric cancer. Three in four carriers of the gene will develop the disease. Such cases make up a small share of all stomach cancers, but given the extremely high cancer risk, people with the gene are typically advised to undergo a prophylactic gastrectomy (preventive surgical removal of the stomach).

More Information: 

N Engl J Med 2001; 344(25): 1904-09
N Engl J Med 2001; 344: 1942-44
Adjuvant therapy improves long-term survival for patients with early-stage stomach cancer

Adjuvant therapy improves long-term survival for patients with early-stage stomach cancer

Badge indicating that research was paid for using federal funds

In 2001, a major trial shows that giving patients chemotherapy and radiation after surgery – an approach known as adjuvant therapy – significantly improves survival. The study compared surgery alone with surgery followed by the chemotherapy drugs fluorouracil and leucovorin, together with radiation.

These findings quickly establish adjuvant chemotherapy and radiation as a standard of care, and make stomach cancer one of several cancers in which adjuvant therapy can increase patients' chances of cure.

More Information: 

N Engl J Med; 345(10)
Journal of Clinical Oncology 2012; 30(19): 2327-33

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