Stomach cancer should no longer be considered a disease only of older people, and patients under 40 with chronic digestive symptoms should be more actively investigated – especially if they are of Latin American ethnicity. This advice follows new data from a retrospective, observational study in Mexico which showed that one in seven of over 2,000 patients diagnosed with gastric cancer between 2004 and 2016 were under 40.
Helicobacter pylori, a specific strain of bacteria found more often in East Asian patients may be a risk factor for stomach cancer. Doctors want to identify who is most at risk for cancer carrying out a pilot study that would shape treatment and screening strategies for patients infected with this bacterium. Dr. Nina Salama considers that the global differences in stomach cancer risk can be partly attributed to differences in H. pylori itself. One way that H. pylori varies is in the CogA gene which encodes a toxin that helps the bacterium better attach to cells lining the stomach.
Understanding the mutation in the MUC16 gene may be vital to help predict the outcome of the disease as well as possible treatments available for gastric cancer patients. The MUC16 mutation is thought to increase cancer cell’s susceptibility to immunotherapies. Although the genetics of gastric cancer varies greatly from person to person, mutations in the MUC16 gene are very common in gastric cancer as well as other types of cancer. Researchers at Wake Forest University analyzed this mutation and found that MUC16 mutations affects 38.4% of stomach cancer. Moreover, samples containing MUC16 were 1.87 times more likely to have additional mutations. However, patients with the MUC16 mutation lived longer than those with the unaltered gene with a 39% increase in survival. The researchers believe that the use of therapeutic regimens to abrogate immune inhibition may be beneficial for patients with gastric cancer who have MUC16 mutations.
Researchers at Spain’s Universitat Politecnica de Valenicia studied the effects of lycopene in the body. Lycopene is an antioxidant found in several fruits and tomatoes, hence it is also found in ketchup. Researchers found that lycopene is more potent in the sauce rather than the fruits because it has been cooked down thus facilitation absorption in the body. This is relevant because previous studies have shown that the consumption of tomatoes inhibit cell growth which can help to guard off gastric cancer. Furthermore, increasing levels of healthy bacteria in the gut can decrease the risk of gastric cancer. Another recommendation is to eliminate the use of cigarettes as it can double the risk of gastric cancer. Lastly, lowering the consumption of salt is recommended as it can have negative effects to diets.
The RAINBOW study pre-treated patients with the doublet of fluoropyrimidine plus a platinum, and later gave paclitaxel plus or minus ramucirumab. Survival rates for this study increased to more than 2 months. Another second line study, REGARD lead by Charlie Fuchs, consisted of best supportive care plus a placebo or best supportive care plus ramucirumab. Looking at both studies together we can say that ramucirumab plus paclitaxel is fit for patients in the second line treatment given as the mean survival of the RAINBOW study was around 9 months for the combination.
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.
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.
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.
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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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