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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John Hopkins Kimmel Cancer Center researchers developed a single blood test that can detect for eight common cancer types through assessment of the circulating proteins and mutations in cell-free DNA. The test, called CancerSEEK, is a unique noninvasive, multianalyte test that simultaneously evaluates levels of eight cancer proteins and the presence of cancer gene mutations from circulating DNA in the blood. The test was evaluated on 1,005 patients with nonmetastatic, stages I to III cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung or breast. For the five cancers that have no screening tests—ovarian, liver, stomach, pancreatic and esophageal cancers— the median overall sensitivity, or the ability to find cancer sensitivity ranged from 69 percent to 98 percent. The test had greater than 99 percent specificity for cancer.
Symptoms, Screening & Early Detection
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The goal of this study was to test the effect of HIPEC (Hyperthermic Intraperitoneal Chemotherapy) on survival and postoperative outcomes after complete cytroreductive surgery compared with resection alone. At 3 years, HIPEC significantly improved overall survival with almost 26% of patients alive at 3 years compared with 13% of patients in the surgery alone group. The median overall survival was 18.8 months for patients treated with HIPEC compared to 12.1 months for surgery alone. Survival results at 5 years were consistent. About 20% of patients were still alive at 5 years, and 15% of patients were considered cured by HIPEC. In conclusion, cytoreductive surgery plus HIPEC improved overall survival compared with resection alone for patients with gastric cancer with peritoneal carcinomatosis.
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Gastrointestinal toxicity is common during cancer therapy, and most treatment options are not helpful for the majority of patients. A recent study using a mixture of amino acids show decreases in mucositis and gastrointestinal toxicity following irradiation. This study was conducted in order to evaluate how the amino acid-based beverage benefited cancer patients receiving chemotherapy and/or radiation therapy. The use of the beverage was shown to reduce gastrointestinal toxicity in patients undergoing cancer treatment. There will be additional clinical studies to further effects of how this medical food to evaluate the benefits.
Medical marijuana can exist in a variety of formulations such as dried flowers, resins, extracts and oils. It’s legalization and use for medical purposes is still a developing issue and the perspectives of many health care providers is also following the same path. Medical marijuana can be used to ease chronic pain, chemotherapy-induced nausea and vomiting (CINV), sleeping disorders and certain anticancer agents. Overall, the evolution of medical marijuana is a conflict-ridden issue, but its efficacy has demonstrated as a possible method of treatment for a variety of conditions.
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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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.
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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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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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A study found that endoscopic surveillance can detect gastric cancer at an early curable stage. 279 patients (previous diagnosed with either atrophic gastritis, intestinal metaplasia, or dysplasia) underwent at least one surveillance endoscopy. 84% of the patients were Caucasian. The first surveillance endoscopy was conducted after a mean interval of 35 months with a mean of 2.9 endoscopies per patient. 26% of patients were found to be infected with Helicobacter pylori. Surveillance also helped the diagnosis of 4% of patients with atrophic gastritis, 87% with intestinal metaplasia, and 9% with dysplasia. Four participants were detected to have high-grade adenoma/dysplasia or invasive neoplasia over a mean follow-up of 57 months. Two of these patients were treated successfully with endoscopic submucosal dissection; the other two patients went through total gastrectomy. However, it is reported that examination of tissues is not enough to discriminate between low-risk and high-risk cancer patients. Serological tests are noninvasive and could help identify risk levels while reducing the dependence on endoscopic resources. Gastric and oral gastric microbes can help diagnose stomach cancer and its precursors less invasively as well.
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