Gastric Cancer Treatment Protocols: General Treatment Recommendations, Neoadjuvant Chemoradiotherapy Regimens, Perioperative Chemotherapy Regimens

Sections

Sections Gastric Cancer Treatment Protocols
General Treatment Recommendations
Neoadjuvant Chemoradiotherapy Regimens
Perioperative Chemotherapy Regimens
Postoperative Chemoradiotherapy Regimens
Postoperative Chemotherapy Regimens
First-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)
Second-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)
Show All
References

General Treatment Recommendations

Tumors involving the esophagogastric junction (EGJ) with the tumor epicenter no more than 2 cm into the proximal stomach are staged as esophageal cancers, while EGJ tumors with their epicenter located more than 2 cm into the proximal stomach are staged as stomach cancers, as are all cardia cancers not involving the EGJ.

Treatment decisions should be made with a multidisciplinary team^[1] and based on the following:

Stage of disease
Surgical fitness of the patient
The patient’s preference
Patient comorbidities

Stage 0 to IA

Surgery is the primary treatment for early-stage gastric cancer. Complete surgical resection offers the potential for long-term survival.

Laparoscopic resection is an emerging modality that may improve operative mortality, but requires additional investigation.^[2]Endoscopic mucosal resection and endoscopic submucosal dissection should be performed only in experienced medical centers.^[1]

Stage IB to IIIC, potentially resectable

For medically fit patients, perioperative neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is appropriate. Perioperative therapy is common practice, with chemoradiotherapy after surgery showing a clear survival benefit in patients who did not receive preoperative chemotherapy^[3]. For patients who received preoperative chemotherapy, the addition of postoperative radiotherapy has not demonstrated additional benefit.^[4]

Medically unfit patients can be treated with chemoradiotherapy or chemotherapy.

Stage IV

Chemotherapy based around a doublet or triplet platinum/fluoropyrimidine combination is given for metastatic disease. Local therapy is not indicated. HER2 and PD-L1 testing are recommended upon confirmation of metastatic disease.^{[1, 5]}

Trastuzumab should be added to first-line chemotherapy in HER2-NEU overexpressing metastatic adenocarcinomas.^{[6, 5]}

Preferred regimens

A higher level of evidence supports use of the following regimens; clinical trials have shown strong benefit and there is consensus among experts^[1]:

Paclitaxel 50 mg/m² IV on day 1 plus carboplatin AUC 2 IV on day 1; weekly for 5 wk^{[7, 8]}(see the Carboplatin AUC Dose Calculation [Calvert formula] calculator)or
Cisplatin 75-100 mg/m² IV on day 1 plus 5-fluorouracil (5-FU) 750-1000 mg/m²/day IV continuous infusion on days 1-4 and 29-32; single 35-day cycle^[9] or
Cisplatin 30 mg/m² IV on day 1 plus capecitabine 800 mg/m² PO BID on days 1-5; weekly for 5wk^[10] or
Cisplatin 15 mg/m² IV daily on days 1-5 and days 22-26 plus 5-FU 800 mg/m²/day IV continuous infusion on days 1-5 and days 22-26; single 35-day cycle^[11] or
Oxaliplatin 85 mg/m² IV on days 1, 15, and 29 plus capecitabine 625 mg/m² PO BID on days 1-5, 8-12, 15-19, 22-26, and 29-33; single 35-day cycle^[12]or
Oxaliplatin 85 mg/m² on days 1, 15, and 29 plus 5-FU 180 mg/m² continuous IV infusion daily on days 1-33^[13] or
Oxaliplatin 85 mg/m² IV on day 1 plus leucovorin 400 mg/m² IV on day 1 plus 5-FU 400 mg/m² IVP on day 1 and 5-FU 800 mg/m² continuous IV infusion daily on days 1 and 2; every 14 d for three cycles with radiation and three cycles after radiation^[14]

Other regimens

A lower level of evidence supports use of the following regimens; smaller studies show benefit of the therapy, and therapy may need to be used on the basis of the clinical situation (eg, limiting toxicities, patient comorbidity)^[1]:

Oxaliplatin 45-50 mg/m² IV on day 1 weekly for 5 wk plus 5-FU 225 mg/m² IV daily on days 1-33; single 35-day cycle^[15] or
Carboplatin AUC 6 IV on days 1 and 22 plus 5-FU 200 mg/m² IV daily on days 1-42^[16] or
Irinotecan 65 mg/m² IV on days 1, 8, 22, and 29 plus cisplatin 30 mg/m² IV on days 1, 8, 22, and 29^[17]or
Paclitaxel 45-50 mg/m² IV on day 1 plus 5-FU 300 mg/m² continuous IV infusion daily on days 1-5; weekly for 5 wk^[18] or
Paclitaxel 45-50 mg/m² IV on day 1 plus capecitabine 625-825 mg/m² PO BID daily on days 1-5; weekly for 5 wk^{[18, 19]}

Perioperative Chemotherapy Regimens

The following regimens consist of three cycles before surgery and three cycles after surgery; the following regimens are used only for adenocarcinoma of the distal esophagus or gastroesophageal junction^[1] ("ECF" regimen and variants):

Epirubicin 50 mg/m² IV on day 1 plus cisplatin 60 mg/m² IV on day 1 plus 5-FU 200 mg/m²/day IV continuous infusion daily for days 1-21; every 21 d for six cycles—three preoperatively and three postoperatively^[3] or
Epirubicin 50 mg/m² IV on day 1 plus oxaliplatin 130 mg/m² IV on day 1 plus 5-FU 200 mg/m²/day IV continuous infusion daily for days 1-21; every 21 d for six cycles—three preoperatively and three postoperatively^[20] or
Epirubicin 50 mg/m² IV on day 1 plus cisplatin 60 mg/m² IV on day 1 plus capecitabine 625 mg/m² PO BID daily for days 1-21; every 21 d for six cycles—three preoperatively and three postoperatively^[20] or
Epirubicin 50 mg/m² IV on day 1 plus oxaliplatin 130 mg/m² IV on day 1 plus capecitabine 625 mg/m² PO BID daily for days 1-21; every 21 d for six cycles—three preoperatively and three postoperativelyy^[20] or

See the list below:

Cisplatin 75-80 mg/m ² IV on day 1 plus 5-FU 800 mg/m ² continuous IV infusion on days 1-5; every 28 d; two or three cycles preoperatively and three or four cycles postoperatively for a total of six cycles ^[21]

The following regimen consists of four 14-day cycles preoperatively and then adjuvant therapy with the same regimen ("FLOT" regimen):

5-FU 2600 mg/m ² IV plus folinic acid 200 mg/m ² plus oxaliplatin 85 mg/m ² plus docetaxel 50 mg/m ² ^[22]

Postoperative Chemoradiotherapy Regimens

Uses of the following postoperative chemoradiotherapy regimens include cancers of the gastroesophageal junction:

Leucovorin 20 mg/m² IVP on days 1-5 plus 5-FU 425 mg/m² IVP daily on days 1-5, every 28 d (cycles 1, 3, and 4 given before and after radiation); for cycle 2, give leucovorin 20 mg/m² IVP on days 1-4 and 31-33 plus 5-FU 400 mg/m² IVP daily on days 1-4, every 35 d (cycle 2 given with radiation)^[23]

Note: The National Comprehensive Cancer Network (NCCN) panel does not recommend the above specified doses or schedule, because of concerns regarding toxicity; instead, the panel recommends using one of the following modified regimens.^[1]

One cycle before and two cycles after chemoradiation:

Capecitabine 750-1000 mg/m² PO BID on days 1-14; every 28 d (one cycle before and two cycles after chemoradiation)
Leucovorin 400 mg/m² IV on days 1 and 15 or days 1, 2, 15, and 16 plus 5-FU 400 mg/m² IVP on days 1 and 15 or days 1, 2, 15, and 16 and 5-FU 1200 mg/m² continuous IV infusion over 24 h daily on days 1, 2, 15 and 16, every 14 d (one cycle before radiation and two cycles after radiation)^[24]

With radiation:

5-FU 200-250 mg/m²/day continuous IV infusion on days 1-5 or 1-7; weekly for 5 wk^[25] or
Capecitabine 625-825 mg/m² PO BID daily for days 1-5 or 1-7; weekly for 5 wk^[26]

Postoperative Chemotherapy Regimens

Postoperative chemotherapy regimens for patients who underwent D2 lymph node dissection include the following:

Oxaliplatin 130 mg/m² IV on day 1 plus capecitabine 1000 mg/m² PO BID on days 1-14; every 21 d for eight cycles^[27] or
Cisplatin 60 mg/m² IV on day 1 plus capecitabine 1000 mg/m² PO BID on days 1-14; every 21 d for six cycles^[28]

In one trial, postoperative adjuvant chemotherapy with capecitabine and cisplatin compared with postoperative chemoradiotherapy showed inferior disease-free survival, which may suggest that in patients who have undergone D2 lymph node dissection, chemoradiotherapy may be superior. However, this requires further study.^[29]

Compared with adjuvant chemotherapy, observation postoperatively leads to decreased overall survival.^[30]

Stage IV

For HER2-NEU overexpressing adenocarcinomas, trastuzumab should be added to first-line chemotherapy consisting of cisplatin plus a fluoropyrimidine (eg, 5-FU, capecitabine) but is not recommended in regimens containing an anthracycline.^[1] Trastuzumab is used as follows:

Trastuzumab 8 mg/kg IV loading dose on day 1 of cycle one, then 6 mg/kg IV; every 21 d with chemotherapy^[31] or
Trastuzumab 6 mg/kg IV loading dose on day 1 of cycle one, then 4 mg/kg IV every 14 d with chemotherapy

Preferred regimens^[1]

Two-drug regimens are preferred because of lower toxicity; reserve three-drug regimens for patients who are medically fit and have access to frequent follow-up:

Docetaxel 75 mg/m² IV on day 1 plus cisplatin 75 mg/m² IV on day 1 plus 5-FU 1000 mg/m²/day continuous IV infusion on days 1-5; every 28 d^[32]

Note that the NCCN panel does not recommend the above specified doses or schedule because of concerns regarding toxicity, and instead suggests using one of the following modified regimens:

Docetaxel 40 mg/m² IV on day 1 plus leucovorin 400 mg/m² IV on day 1 plus 5-FU 400 mg/m² IV on day 1 plus 5-FU 1000 mg/m²/day continuous IV infusion on days 1 and 2 plus cisplatin 40 mg/m² IV on day 3; every 14 d^[33] or
Docetaxel 50 mg/m² IV on day 1 plus oxaliplatin 85 mg/m² IV on day 1 plus 5-FU 1200 mg/m²/day continuous IV infusion on days 1 and 2; every 14 d^[34] or
Docetaxel 75 mg/m² IV on day 1 plus carboplatin AUC 6 IV on day 2 plus 5-FU 1200 mg/m²/day continuous IV infusion on days 1-3; every 21 d^[35] or
Epirubicin 50 mg/m² IV on day 1 plus cisplatin 60 mg/m² IV on day 1 plus 5-FU 200 mg/m²/day continuous IV infusion on days 1-21; every 21 d^{[36, 37]} or
Epirubicin 50 mg/m² IV on day 1 plus oxaliplatin 130 mg/m² on day 1 plus 5-FU 200 mg/m²/day continuous IV infusion on days 1-21; every 21 d^[37] or
Epirubicin 50 mg/m² IV on day 1 plus cisplatin 60 mg/m² IV on day 1 plus capecitabine 625 mg/m² PO BID daily on days 1-21; every 21 d^[37] or
Epirubicin 50 mg/m² IV on day 1 plus oxaliplatin 130 mg/m² IV on day 1 plus capecitabine 625 mg/m² PO BID daily on days 1-21; every 21 d^[37] or
Cisplatin 75-100 mg/m² IV on day 1 plus 5-FU 750-1000 mg/m²/day continuous IV infusion over 24 h on days 1-4; every 28 d^[38] or
Cisplatin 50 mg/m² IV on day 1 plus leucovorin 200 mg/m² IV on day 1 plus 5-FU 2000 mg/m²/day continuous IV infusion on day 1; every 14 d^{[39, 40]} or
Cisplatin 80 mg/m² IV on day 1 plus capecitabine 1000 mg/m² PO BID daily on days 1-14; every 21 d^{[31, 41]}
Oxaliplatin 85 mg/m² IV on day 1 plus leucovorin 400 mg/m² IV on day 1 plus 5-FU 400 mg/m² IVP on day 1 plus 5-FU 1200 mg/m²/day continuous IV infusion on days 1 and 2; every 14 d^[42] or
Oxaliplatin 85 mg/m² IV on day 1 plus leucovorin 200 mg/m² IV on day 1 plus 5-FU 2600 mg/m²/day continuous IV infusion on day 1; every 14 d^[39] or
Oxaliplatin 130 mg/m² IV on day 1 plus capecitabine 1000 mg/m² PO BID on days 1-14; every 21 d^[43]
Irinotecan 80 mg/m² IV on day 1 plus leucovorin 500 mg/m² IV on day 1 plus 5-FU 2000 mg/m²/day continuous IV infusion on day 1; weekly for 6 wk followed by 1 wk off treatment^[44] or 2 wk off treatment^{[45, 46]}or
Irinotecan 150 mg/m² IV on day 1 plus leucovorin 20 mg/m² IV on day 1 plus 5-FU 1000 mg/m² /day continuous IV infusion on days 1 and 2; every 14 d^[47]

Other regimens^[1]

Paclitaxel 135-200 mg/m² IV on day 1 plus cisplatin 75 mg/m² IV on day 2; every 21 d^[48] or
Paclitaxel 90 mg/m² IV on day 1 plus cisplatin 50 mg/m² IV on day 1; every 14 d^[49] or
Paclitaxel 200 mg/m² IV on day 1 plus carboplatin AUC 5 IV on day 1; every 21 d^[50] or
Docetaxel 70-85 mg/m² IV on day 1 plus cisplatin 70-75 mg/m² IV on day 1; every 21 d^{[51, 52, 53]} or
Docetaxel 35 mg/m² IV on days 1 and 8 plus irinotecan 50 mg/m² IV on days 1 and 8; every 21 d^[54] or
Leucovorin 400 mg/m² IV on day 1 plus 5-FU 400 mg/m² IVP on day 1 plus 5-FU 1200 mg/m²/day continuous IV infusion on days 1 and 2; every 14 d^[40] or
5-FU 800 mg/m²/day continuous IV infusion on days 1-5; every 28 d^[55] or
Capecitabine 1000-1250 mg/m² PO BID daily on days 1-14; every 21 d^[56] or
Docetaxel 75-100 mg/m² IV on day 1; every 21 d^[57] or
Paclitaxel 135-250 mg/m² IV on day 1; every 21 d^[58] or
Paclitaxel 80 mg/m² IV on day 1 weekly; every 28 d^[59]

Stage IV

Trastuzumab 8 mg/m² IV loading dose on day 1 of cycle one, then 6 mg/m² IV; every 21 d with chemotherapy^[31]or
Trastuzumab 6 mg/kg IV loading dose on day 1 of cycle one, then 4 mg/kg IV every 14 d with chemotherapy

Preferred regimens^[1]:

Ramucirumab 8 mg/kg IV on day 1; every 14 d^[60] or
Ramucirumab 8 mg/kg IV on days 1 and 15 plus paclitaxel IV 80 mg/m² on days 1, 8, and 15; every 28 d^[61] or
Docetaxel 75-100 mg/m² IV on day 1; every 21 d^[57] or
Paclitaxel 135-250 mg/m² IV on day 1; every 21 d^[58] or
Paclitaxel 80 mg/m² IV on day 1 weekly; every 28 d^[59] or
Paclitaxel 80 mg/m² IV on days 1, 8, and 15; every 28 d^[62] or
Irinotecan 250-350 mg/m² IV on day 1; every 21 d^[63] or
Irinotecan 150-180 mg/m² IV on day 1; every 14 d^{[64, 65, 62]} or
Irinotecan 125 mg/m² IV on days 1 and 8; every 21 d^{[64, 65]}

For MSI-high or deficient MMR tumors that have progressed despite fluoropyrimidine- and platinum-containing chemotherapy ^[66] :

Pembrolizumab 200mg IV on day 1; every 21 d^{[67, 68]}

Metastatic gastric or gastroesophageal junction adenocarcinoma tumors expressing PD-L1 ≥ 1 (or third line or subsequent therapy)^[69]:

Pembrolizumab 200mg IV on day 1; every 21 d^[70]

Other regimens^[1]:

Irinotecan 65 mg/m² IV on days 1 and 8 plus cisplatin 25-30 mg/m² IV on days 1 and 8; every 21 d^{[42, 71]} or
Irinotecan 250 mg/m² IV on day 1 plus capecitabine 1000 mg/m² PO BID daily on days 1-14; every 21 d^[72] or
Irinotecan 180 mg/m² IV on day 1 plus leucovorin 400 mg/m² IV on day 1 plus 5-FU 400 mg/m² IVP on day 1 plus 5-FU 600-1200 mg/m²/day continuous IV infusion on days 1 and 2; every 14 d^{[73, 74]} or
Docetaxel 35 mg/m² IV on days 1 and 8 plus irinotecan 50 mg/m² IV on days 1 and 8; every 21 d^[54]

Alternative regimens to consider:

Mitomycin 6 mg/m² IV on day 1 plus irinotecan 125 mg/m² on days 2 and 9; every 28 d^[75] or
Irinotecan 150 mg/m² IV on days 1 and 15 plus mitomycin 8 mg/m² IV on day 1; every 28 d^[76] or
Irinotecan 125 mg/m² IV on day 1 plus mitomycin 5 mg/m² IV on day 1; every 14 d^[77] or
Mitomycin 10 mg/m² IV on days 1 and 22 plus leucovorin 500 mg/m² IV on day 1 plus 5-FU 2600 mg/m²/day continuous IV infusion on day 1; weekly for 6 wk, followed by 2 wk off treatment^[78] or
Regorafenib 160 mg PO daily on days 1 to 21; every 28 d ^[79] or
Nivolumab 3 mg/kg IV on day 1; every 14 d^[80]

[Guideline] National Comprehensive Cancer Network. Gastric Cancer. NCCN Clinical Practice Guidelines in Oncology. Available at https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Version 2.2018 — May 22, 2018;
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005 Feb. 241 (2):232-7. [Medline].
Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6. 355(1):11-20. [Medline].
[Guideline] Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016 Sep. 27 (suppl 5):v38-v49. [Medline].
[Guideline] Bartley AN, Washington MK, Colasacco C, et al. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society of Clinical Oncology. J Clin Oncol. 2017 Feb. 35 (4):446-464. [Medline].
Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki 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 Aug 28. 376 (9742):687-97. [Medline].
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31. 366(22):2074-84. [Medline]. [Full Text].
van Meerten E, Muller K, Tilanus HW, et al. Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study. Br J Cancer. 2006 May 22. 94(10):1389-94. [Medline].
Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol. 2008 Mar 1. 26(7):1086-92. [Medline].
Lee SS, Kim SB, Park SI, et al. Capecitabine and cisplatin chemotherapy (XP) alone or sequentially combined chemoradiotherapy containing XP regimen in patients with three different settings of stage IV esophageal cancer. Jpn J Clin Oncol. 2007 Nov. 37(11):829-35. [Medline].
Bedenne L, Michel P, Bouché O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007 Apr 1. 25(10):1160-8. [Medline].
Javle MM, Yang G, Nwogu CE, et al. Capecitabine, oxaliplatin and radiotherapy: a phase IB neoadjuvant study for esophageal cancer with gene expression analysis. Cancer Invest. 2009 Feb. 27(2):193-200. [Medline].
Khushalani NI, Leichman CG, Proulx G, et al. Oxaliplatin in combination with protracted-infusion fluorouracil and radiation: report of a clinical trial for patients with esophageal cancer. J Clin Oncol. 2002 Jun 15. 20(12):2844-50. [Medline].
Conroy T, Viret F, François E, et al. Phase I trial of oxaliplatin with fluorouracil, folinic acid and concurrent radiotherapy for oesophageal cancer. Br J Cancer. 2008 Nov 4. 99(9):1395-401. [Medline].
Lorenzen S, Brücher B, Zimmermann F, et al. Neoadjuvant continuous infusion of weekly 5-fluorouracil and escalating doses of oxaliplatin plus concurrent radiation in locally advanced oesophageal squamous cell carcinoma: results of a phase I/II trial. Br J Cancer. 2008 Oct 7. 99(7):1020-6. [Medline].
Zemanova M, Petruzelka L, Pazdro A, et al. Prospective non-randomized study of preoperative concurrent platinum plus 5-fluorouracil-based chemoradiotherapy with or without paclitaxel in esophageal cancer patients: long-term follow-up. Dis Esophagus. 2010 Feb. 23(2):160-7. [Medline].
Sharma R, Yang GY, Nava HR, et al. A single institution experience with neoadjuvant chemoradiation (CRT) with irinotecan (I) and cisplatin (C) in locally advanced esophageal carcinoma (LAEC). 2009.
Ajani JA, Winter K, Okawara GS, et al. Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904): quality of combined modality therapy and pathologic response. J Clin Oncol. 2006 Aug 20. 24(24):3953-8. [Medline].
Czito BG, Kelsey CR, Hurwitz HI, et al. A Phase I study of capecitabine, carboplatin, and paclitaxel with external beam radiation therapy for esophageal carcinoma. Int J Radiat Oncol Biol Phys. 2007 Mar 15. 67(4):1002-7. [Medline].
Sumpter K, Harper-Wynne C, Cunningham D, et al. Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer. 2005 Jun 6. 92(11):1976-83. [Medline]. [Full Text].
Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011 May 1. 29(13):1715-21. [Medline].
Al-Batran SE, Hofheinz RD, Pauligk C, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol. 2016 Dec. 17 (12):1697-1708. [Medline].
Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001 Sep 6. 345(10):725-30. [Medline].
André T, Quinaux E, Louvet C, et al. Phase III study comparing a semimonthly with a monthly regimen of fluorouracil and leucovorin as adjuvant treatment for stage II and III colon cancer patients: final results of GERCOR C96.1. J Clin Oncol. 2007 Aug 20. 25(24):3732-8. [Medline].
Leong T, Joon DL, Willis D, et al. Adjuvant chemoradiation for gastric cancer using epirubicin, cisplatin, and 5-fluorouracil before and after three-dimensional conformal radiotherapy with concurrent infusional 5-fluorouracil: a multicenter study of the Trans-Tasman Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2011 Mar 1. 79(3):690-5. [Medline].
Lee HS, Choi Y, Hur WJ, et al. Pilot study of postoperative adjuvant chemoradiation for advanced gastric cancer: adjuvant 5-FU/cisplatin and chemoradiation with capecitabine. World J Gastroenterol. 2006 Jan 28. 12(4):603-7. [Medline].
Chua YJ, Barbachano Y, Cunningham D, Oates JR, Brown G, Wotherspoon A, et al. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 2010 Mar. 11(3):241-8. [Medline].
Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012 Jan 28. 379(9813):315-21. [Medline].
Park SH, Sohn TS, Lee J, et al. Phase III Trial to Compare Adjuvant Chemotherapy With Capecitabine and Cisplatin Versus Concurrent Chemoradiotherapy in Gastric Cancer: Final Report of the Adjuvant Chemoradiotherapy in Stomach Tumors Trial, Including Survival and Subset Analyses. J Clin Oncol. 2015 Oct 1. 33 (28):3130-6. [Medline].
Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011 Nov 20. 29 (33):4387-93. [Medline].
Bang YJ, 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 Aug 28. 376(9742):687-97. [Medline].
Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006. 24:4991-7.
Shah MA, Shibata S, Stroller RG. Random assignment multicenter phase II study of modified docetaxel, cisplatin, fluorouracil (mDCF) versus DCF with growth factor support (GCSF) in metastatic gastroesophageal adenocarcinoma (GE). J Clin Oncol (Meeting Abstracts). 2010. 28:4014.
Shankaran V, Mulcahy MF, Hochster HS. Docetaxel, oxaliplatin, and 5-fluorouracil for the treatment of metastatic or unresectable gastric or gastroesophageal junction (GEJ) adenocarcinomas: Preliminary results of a phase II study. 2009.
Elkerm YM, Elsaid A, Al-Batran SE, et al. Final results of a phase II trial of docetaxel-carboplatin-FU in locally advanced gastric carcinoma. 2008.
Ross P, Nicolson M, Cunningham D, et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol. 2002 Apr 15. 20(8):1996-2004. [Medline].
Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008 Jan 3. 358(1):36-46. [Medline].
Lee J, Lim do H, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012 Jan 20. 30(3):268-73. [Medline].
Al-Batran SE, Hartmann JT, Probst S, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol. 2008 Mar 20. 26(9):1435-42. [Medline].
Bouché O, Raoul JL, Bonnetain F, et al. Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study--FFCD 9803. J Clin Oncol. 2004 Nov 1. 22(21):4319-28. [Medline].
Kang YK, Kang WK, Shin DB, et al. Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial. Ann Oncol. 2009 Apr. 20(4):666-73. [Medline].
Enzinger PC, Burtness B, Hollis D, et al. A randomized phase II study of three standard chemotherapy regimens (ECF, IC, FOLFOX) plus cetuximab in metastatic esophageal and GE junction cancer. J Clin Oncol. 2010. 28:15s (suppl; abstr 4006).
Lorenzen S, Schuster T, Porschen R, Al-Batran SE, Hofheinz R, Thuss-Patience P, et al. Cetuximab plus cisplatin-5-fluorouracil versus cisplatin-5-fluorouracil alone in first-line metastatic squamous cell carcinoma of the esophagus: a randomized phase II study of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol. 2009 Oct. 20(10):1667-73. [Medline].
Dank M, Zaluski J, Barone C, et al. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol. 2008 Aug. 19(8):1450-7. [Medline].
Wolff K, Wein A, Reulbach U, et al. Weekly high-dose 5-fluorouracil as a 24-h infusion and sodium folinic acid (AIO regimen) plus irinotecan in patients with locally advanced nonresectable and metastatic adenocarcinoma or squamous cell carcinoma of the oesophagus: a phase II trial. Anticancer Drugs. 2009 Mar. 20(3):165-73. [Medline].
Wolff K, Wein A, Reulbach U, Männlein G, Brückl V, Meier C, et al. Weekly high-dose 5-fluorouracil as a 24-h infusion and sodium folinic acid (AIO regimen) plus irinotecan in patients with locally advanced nonresectable and metastatic adenocarcinoma or squamous cell carcinoma of the oesophagus: a phase II trial. Anticancer Drugs. 2009 Mar. 20(3):165-73. [Medline].
Sym SJ, Hong J, Park J, Cho EK, Lee JH, Park YH, et al. A randomized phase II study of biweekly irinotecan monotherapy or a combination of irinotecan plus 5-fluorouracil/leucovorin (mFOLFIRI) in patients with metastatic gastric adenocarcinoma refractory to or progressive after first-line chemotherapy. Cancer Chemother Pharmacol. 2013 Feb. 71(2):481-8. [Medline].
Ilson DH, Forastiere A, Arquette M, et al. A phase II trial of paclitaxel and cisplatin in patients with advanced carcinoma of the esophagus. Cancer J. 2000 Sep-Oct. 6(5):316-23. [Medline].
Petrasch S, Welt A, Reinacher A, et al. Chemotherapy with cisplatin and paclitaxel in patients with locally advanced, recurrent or metastatic oesophageal cancer. Br J Cancer. 1998 Aug. 78(4):511-4. [Medline].
Gadgeel SM, Shields AF, Heilbrun LK, et al. Phase II study of paclitaxel and carboplatin in patients with advanced gastric cancer. Am J Clin Oncol. 2003 Feb. 26(1):37-41. [Medline].
Roth AD, Fazio N, Stupp R, et al. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase II trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol. 2007 Aug 1. 25(22):3217-23. [Medline].
Ajani JA, Fodor MB, Tjulandin SA, et al. Phase II multi-institutional randomized trial of docetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma. J Clin Oncol. 2005 Aug 20. 23(24):5660-7. [Medline].
Kim JY, Do YR, Park KU, et al. A multi-center phase II study of docetaxel plus cisplatin as first-line therapy in patients with metastatic squamous cell esophageal cancer. Cancer Chemother Pharmacol. 2010 May. 66(1):31-6. [Medline].
Burtness B, Gibson M, Egleston B, et al. Phase II trial of docetaxel-irinotecan combination in advanced esophageal cancer. Ann Oncol. 2009 Jul. 20(7):1242-8. [Medline].
Ohtsu A, Shimada Y, Shirao K, et al. Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: The Japan Clinical Oncology Group Study (JCOG9205). J Clin Oncol. 2003 Jan 1. 21(1):54-9. [Medline].
Hong YS, Song SY, Lee SI, et al. A phase II trial of capecitabine in previously untreated patients with advanced and/or metastatic gastric cancer. Ann Oncol. 2004 Sep. 15(9):1344-7. [Medline].
Albertsson M, Johansson B, Friesland S, et al. Phase II studies on docetaxel alone every third week, or weekly in combination with gemcitabine in patients with primary locally advanced, metastatic, or recurrent esophageal cancer. Med Oncol. 2007. 24(4):407-12. [Medline].
Ajani JA, Ilson DH, Daugherty K, et al. Activity of taxol in patients with squamous cell carcinoma and adenocarcinoma of the esophagus. J Natl Cancer Inst. 1994 Jul 20. 86(14):1086-91. [Medline].
Ilson DH, Wadleigh RG, Leichman LP, et al. Paclitaxel given by a weekly 1-h infusion in advanced esophageal cancer. Ann Oncol. 2007 May. 18(5):898-902. [Medline].
Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014 Jan 4. 383(9911):31-9. [Medline].
Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014 Oct. 15 (11):1224-35. [Medline].
André T, Louvet C, Maindrault-Goebel F, Couteau C, Mabro M, Lotz JP, et al. CPT-11 (irinotecan) addition to bimonthly, high-dose leucovorin and bolus and continuous-infusion 5-fluorouracil (FOLFIRI) for pretreated metastatic colorectal cancer. GERCOR. Eur J Cancer. 1999 Sep. 35(9):1343-7. [Medline].
Thuss-Patience PC, Kretzschmar A, Deist T, et al. Irinotecan versus best supportive care (BSC) as second-line therapy in gastric cancer: A randomized phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). J Clin Oncol. 2009. 27:15s (suppl; abstr 4540).
Fuchs CS, Moore MR, Harker G, et al. Phase III comparison of two irinotecan dosing regimens in second-line therapy of metastatic colorectal cancer. J Clin Oncol. 2003 Mar 1. 21(5):807-14. [Medline].
Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004 Jul 22. 351(4):337-45. [Medline].
U.S. Food and Drug Administration. FDA grants accelerated approval to pembrolizumab for first tissue/site agnostic indication. Available at https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm560040.htm. 2017; Accessed: February 28, 2018.
Le DT, Durham JN, Smith KN, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017 Jul 28. 357 (6349):409-413. [Medline].
Le DT, Uram JN, Wang H, et al. PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. N Engl J Med. 2015 Jun 25. 372 (26):2509-20. [Medline].
United States Food and Drug Administration. FDA grants accelerated approval to pembrolizumab for advanced gastric cancer. United States Food and Drug Administration. Available at https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm577093.htm. 2017 Sep 22; Accessed: March 1, 2017.
Fuchs CS, et al. (abstract 4003) KEYNOTE-059 cohort 1: Efficacy and safety of pembrolizumab (pembro) monotherapy in patients with previously treated advanced gastric cancer. Presented at the American Society of Clinical Oncology annual meeting. Available at http://meetinglibrary.asco.org/record/144521/abstract. June 4, 2017;
Ilson DH. Phase II trial of weekly irinotecan/cisplatin in advanced esophageal cancer. Oncology (Williston Park). 2004 Dec. 18(14 Suppl 14):22-5. [Medline].
Leary A, Assersohn L, Cunningham D, et al. A phase II trial evaluating capecitabine and irinotecan as second line treatment in patients with oesophago-gastric cancer who have progressed on, or within 3 months of platinum-based chemotherapy. Cancer Chemother Pharmacol. 2009 Aug. 64(3):455-62. [Medline].
Di Lauro L, Fattoruso SI, Giacinti L, et al. Second-line chemotherapy with FOLFIRI in patients with metastatic gastric cancer (MGC) not previously treated with fluoropyrimidines. J Clin Oncol. 2009. 27:15s (suppl; abstr 4549).
Kim GM, Jeung HC, Rha SY, Kim HS, Jung I, Nam BH, et al. A randomized phase II trial of S-1-oxaliplatin versus capecitabine-oxaliplatin in advanced gastric cancer. Eur J Cancer. 2012 Mar. 48(4):518-26. [Medline].
Lustberg MB, Bekaii-Saab T, Young D, et al. Phase II randomized study of two regimens of sequentially administered mitomycin C and irinotecan in patients with unresectable esophageal and gastroesophageal adenocarcinoma. J Thorac Oncol. 2010 May. 5(5):713-8. [Medline].
Giuliani F, Molica S, Maiello E, et al. Irinotecan (CPT-11) and mitomycin-C (MMC) as second-line therapy in advanced gastric cancer: a phase II study of the Gruppo Oncologico dell' Italia Meridionale (prot. 2106). Am J Clin Oncol. 2005 Dec. 28(6):581-5. [Medline].
Bamias A, Papamichael D, Syrigos K, et al. Phase II study of irinotecan and mitomycin C in 5-fluorouracil-pretreated patients with advanced colorectal and gastric cancer. J Chemother. 2003 Jun. 15(3):275-81. [Medline].
Hofheinz RD, Hartung G, Samel S, et al. High-dose 5-fluorouracil / folinic acid in combination with three-weekly mitomycin C in the treatment of advanced gastric cancer. A phase II study. Onkologie. 2002 Jun. 25(3):255-60. [Medline].
Pavlakis N, Sjoquist KM, Martin AJ, et al. Regorafenib for the Treatment of Advanced Gastric Cancer (INTEGRATE): A Multinational Placebo-Controlled Phase II Trial. J Clin Oncol. 2016 Aug 10. 34 (23):2728-35. [Medline].
Kang YK, Boku N, Satoh T, 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. 2017 Dec 2. 390 (10111):2461-2471. [Medline].
Hihara J, Yoshida K, Hamai Y, et al. Phase I study of docetaxel (TXT) and 5-fluorouracil (5-FU) with concurrent radiotherapy in patients with advanced esophageal cancer. Anticancer Res. 2007 Jul-Aug. 27(4C):2597-603. [Medline].
Spigel DR, Greco FA, Meluch AA, et al. Phase I/II trial of preoperative oxaliplatin, docetaxel, and capecitabine with concurrent radiation therapy in localized carcinoma of the esophagus or gastroesophageal junction. J Clin Oncol. 2010 May 1. 28(13):2213-9. [Medline].
Ozal G, Dogan M, Akbulut H. The safety and efficacy of modified-dose docetaxel, cisplatin, and 5-fluorouracil (mDCF) combination in the front-line treatment of advanced gastric cancer. 2010.
Al-Batran SE, Hartmann JT, Hofheinz R, et al. Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol. 2008 Nov. 19(11):1882-7. [Medline].
Samalin E, Afchain P, Thézenas S, et al. Efficacy of irinotecan in combination with 5-fluorouracil (FOLFIRI) for metastatic gastric or gastroesophageal junction adenocarcinomas (MGA) treatment. Gastroenterol Clin Biol. 2010 Oct 28. [Medline].
Vanhoefer U, Rougier P, Wilke H, et al. Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J Clin Oncol. 2000 Jul. 18(14):2648-57. [Medline].
Taal BG, Teller FG, ten Bokkel Huinink WW, et al. Etoposide, leucovorin, 5-fluorouracil (ELF) combination chemotherapy for advanced gastric cancer: experience with two treatment schedules incorporating intravenous or oral etoposide. Ann Oncol. 1994. 5:90-2.
Cascinu S, Galizia E, Labianca R, et al. Pegylated liposomal doxorubicin, 5-fluorouracil and cisplatin versus mitomycin-C, 5-fluorouracil and cisplatin for advanced gastric cancer: a randomized phase II trial. Cancer Chemother Pharmacol. 2010 Sep 7. [Medline].
Dragovich T, McCoy S, Fenoglio-Preiser CM, et al. Phase II trial of erlotinib in gastroesophageal junction and gastric adenocarcinomas: SWOG 0127. J Clin Oncol. 2006 Oct 20. 24(30):4922-7. [Medline].
Gold PJ, Goldman B, Iqbal S, et al. Cetuximab as second-line therapy in patients with metastatic esophageal adenocarcinoma: a phase II Southwest Oncology Group Study (S0415). 2008.
Ilson DH, Kelsen D, Shah M, et al. A phase 2 trial of erlotinib in patients with previously treated squamous cell and adenocarcinoma of the esophagus. Cancer. 2011 Apr 1. 117(7):1409-14. [Medline].
Jansen EP, Boot H, Saunders MP, Crosby TD, Dubbelman R, Bartelink H, et al. A phase I-II study of postoperative capecitabine-based chemoradiotherapy in gastric cancer. Int J Radiat Oncol Biol Phys. 2007 Dec 1. 69(5):1424-8. [Medline].
Kleinberg L, Powell ME, Forastiere AA, et al. Survival outcome of E1201: An Eastern Cooperative Oncology Group (ECOG) randomized phase II trial of neoadjuvant preoperative paclitaxel/cisplatin/radiotherapy (RT) or irinotecan/cisplatin/RT in endoscopy with ultrasound (EUS) staged esophageal adenocarcinoma. J Clin Oncol. 2008. 26:(May 20 suppl; abstr 4532).
Mezhir JJ, Shah MA, Jacks LM, et al. Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Ann Surg Oncol. 2010 Dec. 17(12):3173-80. [Medline].
Power DG, Schattner MA, Gerdes H, et al. Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer. J Am Coll Surg. 2009 Feb. 208(2):173-8. [Medline].
Rivera F, Galán M, Tabernero J, et al. Phase II trial of preoperative irinotecan-cisplatin followed by concurrent irinotecan-cisplatin and radiotherapy for resectable locally advanced gastric and esophagogastric junction adenocarcinoma. Int J Radiat Oncol Biol Phys. 2009 Dec 1. 75(5):1430-6. [Medline].
Ruhstaller T, Widmer L, Schuller JC, et al. Multicenter phase II trial of preoperative induction chemotherapy followed by chemoradiation with docetaxel and cisplatin for locally advanced esophageal carcinoma (SAKK 75/02). Ann Oncol. 2009 Sep. 20(9):1522-8. [Medline].
Sarela AI, Lefkowitz R, Brennan MF, et al. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg. 2006 Jan. 191(1):134-8. [Medline].
Ueda S, Hironaka S, Yasui H, et al. Randomized phase III study of irinotecan (CPT-11) versus weekly paclitaxel (wPTX) for advanced gastric cancer (AGC) refractory to combination chemotherapy (CT) of fluoropyrimidine plus platinum (FP): WJOG4007 trial. J Clin Oncol 30, 2012 (suppl; abstr 4002). Presented at 2012 ASCO Annual Meeting, Chicago, IL.
Urba SG, Orringer MB, Ianettonni M, et al. Concurrent cisplatin, paclitaxel, and radiotherapy as preoperative treatment for patients with locoregional esophageal carcinoma. Cancer. 2003 Nov 15. 98(10):2177-83. [Medline].
Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011 May 1. 29(13):1715-21. [Medline].

Media Gallery

of 0

Sections Gastric Cancer Treatment Protocols
General Treatment Recommendations
Neoadjuvant Chemoradiotherapy Regimens
Perioperative Chemotherapy Regimens
Postoperative Chemoradiotherapy Regimens
Postoperative Chemotherapy Regimens
First-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)
Second-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)
Show All
References

Gastric Cancer Treatment Protocols

General Treatment Recommendations

Stage 0 to IA

Stage IB to IIIC, potentially resectable

Stage IV

Neoadjuvant Chemoradiotherapy Regimens

Preferred regimens

Other regimens

Perioperative Chemotherapy Regimens

Postoperative Chemoradiotherapy Regimens

Postoperative Chemotherapy Regimens

First-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)

Stage IV

Second-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)

Stage IV

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Gastric Cancer Treatment Protocols

General Treatment Recommendations

Stage 0 to IA

Stage IB to IIIC, potentially resectable

Stage IV

Neoadjuvant Chemoradiotherapy Regimens

Preferred regimens

Other regimens

Perioperative Chemotherapy Regimens

Postoperative Chemoradiotherapy Regimens

Postoperative Chemotherapy Regimens

First-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)

Stage IV

Second-Line Chemotherapy for Metastatic or Locally Advanced Cancer (Where Local Therapy Not Indicated)

Stage IV

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Related Conditions and Diseases

Medscape Consult

News & Perspective

Tools

Slideshow

Most Popular Articles

Recommended