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August 10, 2018 – Analyzing Potential Therapies in Gastric/GEJ Cancer

Current research of esophagogastric cancer is heading toward building on the signals of activity seen for immunotherapy. Though phase I and phase II trials have given a mixed results, scientists are looking forward to the results of first line immunotherapy trials some of which involve the claudin protein in the body. This protein is overexpressed in most gastric cancers and it is a gap junction protein. Claudin protein combined with chemotherapy has shown great data for its phase II trials and will soon be undergoing phase III trials given improved overall survival of esophagogastric patients.  We now know that VEGF-targeted drugs, HER-2 targeted agents, neoadjuvant chemotherapy and radiation added to surgery all improve outcomes in patients with esophagus and gastroesophageal cancers.

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August 09, 2018- Gastric Cancer Mutation Type Linked to Higher Mutational Load, But Better Prognosis

In a recent study, researchers found that MUC16 gene mutations in gastric cancer patients lead to higher mutational loads than patients who do not have these mutations. Furthermore, the researchers also found that MUC16 gene mutations affect the immune system and could in also be used to identify patients who could respond to immunotherapies. Of the samples tested in the study, MUC16 gene mutation samples show to have the highest mutation rates compared to those without MUC16. This phenomenon was attributed to tumor instability which is prevalent in gastric cancer. According to The Cancer Genome Atlas (TCGA) patients with MUC16 mutations survived a median 46.9 months, as compared to 26.7 months for those without. In addition, researchers reported MUC16 mutations appeared to influence expressions of other genes such as cell cycle checkpoints, DNA replication and repair, antiaging processing, and signaling pathways involved in the immune system. Lastly, MUC16 is known to modulate immune response to cancer thus patients with MUC16 mutations could benefit from treatments that boost the immune system.

Molecular Testing
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August 07, 2018- FDA Grants Orphan Drug Designation to Gastric Cancer Treatment, ALT-P7

The FDA recently granted an orphan drug designation to Alteogen Inc.’s ALT-P7 for the treatment of patients with gastric cancer. ALT-P7 is an antibody-drug that utilizes a trastuzumab variant form of antibody. This drug may accelerate the advancement of gastric cancer treatment in the United States. Currently in Korea, this drug is undergoing phase 1 clinical trial for the first time in humans. The phase 1 trial at the moment has an emphasis on the benefits of this drug for breast cancer. However, scientists believe ALT-P7 can be extremely helpful in the treatment of HER-2 overexpressing in gastric cancer.

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August 2018 – Treating Cancer Anywhere

Cancer treatments are typically prescribed for tumors specific to a region of the body. However, last May, the FDA approved the first cancer treatment that can be used for tumors located anywhere in the body, as long as it carries a specific type of genetic mutation: Keytruda (pembrolizab). It is an immune checkpoint inhibitor that can treat any solid tumor with a mismatch repair deficiency (the body cannot fix DNA damage to stop cancer growth). Another experimental drug that can cure tumors anywhere in the body is Larotrectinib. It inhibits tropomyosin receptor kinase (TRK) genes from activating cancer growth. TRK fusion mutations are found in only 1% of all cancers but are responsible for over 90% of some rare cancers. This approval is significant in that people with all types of cancer, not just those who have cancers common enough to have their own clinical trials, can try these new effective immunotherapies. Three out of four patients treated with Larotrectinib responded and over 90% of them were still doing well post-treatment.
Article Source: Highleyman, Liz. (2018). Treating Cancer Anywhere. Cancer Health, pp. 8.
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July 29, 2018- Foods That Stop Cancer: Here’s a List of 10 Anti-Cancer Vegetables You Should Never Forget to Eat

Although green vegetables are great at preventing cancer, a new study published in the International Journal of Cancer states that in addition to cruciferous vegetables, orange vegetables also contribute to lowering risk of cancer. The reason behind this is not well understood yet, however, they are thought to have high micronutrients, antioxidants and fiber which can can prevent tumors in the genesis stage. Cruciferous vegetable such as cauliflower, cabbage and broccoli are known to be the best at lowering the risk of cancer. These types of vegetables have a high content of sulforaphane and are known to reduce the risk of breast cancer, prostate cancer and colorectal cancer. In addition to these, kale is also a great vegetable to prevent breast, lung, esophagus, bladder, mouth and other kinds of cancer. Moreover, tomatoes, peppers, white grapefruit and watermelons are rich in vitamin C which helps the immune system fight off cancerous cells and tomatoes also contain other carotenoids, such as lycopene, that help avoid cancer. Oranges, which are also rich in vitamin C, are very effective at preventing mouth, esophagus and stomach cancer by 50 percent. Finally, consuming carrots and beans can also be very beneficial in the fight against stomach cancer with carrots reducing the risk of this type of cancer by 26 percent and beans reducing the risk of colorectal tumors by 75 percent.
Nutrition Information
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July 27, 2018 – Optimal Perioperative Chemotherapy in Gastric/GEJ Cancer

Traditionally, preoperative chemotherapy without radiation is used following the standard Britsh regimen which combines epirubicin platinum and 5-FU (both drugs used for chemotherapy). However, recently the Germans developed the FLOT regimen which essentially is a modified FOLFOX with an addition of docetaxel. Following this development, they decided to compare their new regimen FLOT versus the old regimen ECF or ECX, with a primary focus on overall survival in over 700 patients with gastroesophageal junction and gastric cancers. The comparison was necessary to determine whether the new regimen could potentially replace the old as the standard regimen for preoperative chemotherapy without radiation. Moreover, the results from this comparison suggested that the overall survival of the participants was significantly improved from 18 to 30 months with FLOT. Ultimately in a patient who can tolerate 3-drug therapy, the FLOT regimen has become a new standard and for distal gastric patients, as Dr.David Ilson states, this should become the new standard of care as well given how successful it has been in the trials. Some adjustments must be made on the doses prescribed to each patient to avoid high levels of toxicity however, this should not compromise the efficacy of the regimen.
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June 28, 2018 – Molecular testing in Metastatic Gastric/GEJ Cancer

DDF’s Scientific and Medical Advisory Board Chair, David Ilson, MD, PhD, explains that when it comes to a patient with metastatic disease molecular testing does have an impact on choices of therapy. More specifically HER2 testing is a common in patients with metastatic disease. If a patient is HER2-positive, then trastuzumab is included as part of the chemotherapy for that patient. Moreover, for metastatic patients, physicians also consider microsatellite instability testing, DNA mismatch repair protein testing, or PD-L1 testing given as how the outcome of these tests may influence treatment. When a young patient under the age of 50 is diagnosed with gastric cancer, it is prudent to think about CDH1 or hereditary diffuse gastric cancer. Genetic testing is used for these types of patients and it is commonly found that heritable mutations are not present unless there is a family history of gastric cancer in their families. Genetic testing is more commonly used in younger patients than in older patients, nevertheless, in very rare occasions that heritable mutations are found.
Genetic Testing
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June 22, 2018 – Dendritic Cell Vaccine Plus Salvage Chemotherapy Active in Gastric Cancer

A recent study found that a dendritic cell (DC) vaccine administered with chemotherapy was safe and effective for gastric cancer treatment. 28 patients with refractory or advanced gastric cancer were treated with a DC vaccine every 2 weeks for a total of 7 doses while also undergoing chemotherapy. The results showed two partial response cases, seven patients maintained stable disease, and 11 patients developed disease progression. During a follow-up after a median of 10.3 months, the median overall survival from the date of first vaccination was 10.5 months. Overall survival was longer among patients who experienced a partial response or stable disease (26.3 months) than patients who did not respond to treatment {6.4 months). Differences among various types of immune cell frequencies were noted between the responding and not responding patients. The therapy was well tolerated by patients with no serious adverse effects, except for hematologic toxicities.
Clinical Trials
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June 21, 2018 – TAS-102 Prolongs Survival in Phase III Gastric Cancer Study

According to a recent study, TAS-102 (trifluridine/tipiracil; Lonsurf) provided a 31% reduction in the risk of death for patients with heavily pretreated metastatic or advanced gastric cancer that received the drug compared to patients who received a placebo. The median overall survival time was 5.7 months for patients who received TAS-102 compared with 3.6 months for patients that received the placebo. 21.2% patients survived a year following treatment compared with 13.0% of patients that received the placebo. Studies on the efficacy and safety of TAS-102 revealed that TAS-102 has a predictable and manageable safety profile.
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June 18, 2018 – Adjuvant Chemotherapy Advances Boost Outcomes in GI Malignancies

In gastric cancer, results from a FLOT4 clinical trial suggest that the FLOT (fluorouracil/leucovorin, oxaliplatin, and docetaxel [Taxotere]) regimen should be the primary adjuvant treatment in gastric cancer over epirubicin/cisplatin/fluorouracil (ECF) or epirubicin/cisplatin/oxaliplatin (ECX). The trial showed that overall survival was longer for patients assigned to FLOT compared with ECF/ ECX (50 vs 35 months) and are predicted to be more effective for survival long term. Side effects like infections, diarrhea, and neutropenia took place more frequently with FLOT arm but patients receiving ECF/ECX had higher rates of vomiting and nausea. The 2 groups had nearly the same rates of serious adverse events and toxic deaths.
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