News Articles

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.
Treatment Options
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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.
Treatment Options
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June 16, 2018 – Endoscopic Surveillance Detects Early Gastric Cancer

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.
Symptoms, Screening & Early Detection
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June 12, 2018 – Risk of Diabetes May Increase After Cancer Diagnosis

Diabetes is the main cause of cancer-unrelated mortality among cancer survivors. Numerous studies have suggested that diabetes increases risk for developing cancer. A recent South Korean study found that having cancer itself also increases risk for developing diabetes. Researchers followed 494,189 patients between ages 20 and 70 without diabetes and cancer for a median of seven years. A follow-up revealed that 15,130 people developed cancer and 26,610 developed diabetes over time. Based on the results, it can be said that at any given time, 1.35X as many stomach cancer patients will develop diabetes compared to people without cancer. In general, cancer patients develop other clinical problems more frequently than non-cancer patients. Thus, routine diabetes screening should be conducted among stomach cancer patients.
Risk Factors
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June 12, 2018 – Futuristic gene-editing technology may cause cancer

Two studies have suggested that successful gene editing with CRISPR Cas9 (to cure genetic diseases) may be associated with an increased risk of developing cancer. This is because the edit may indicate that the modified cell lacks the cancer-suppressing protein, p53. P53 acts as the body’s cellular “first aid” kit and also causes some CRISPR edits to fail. When CRISPR makes a cut in the DNA of a cell (to remove deleterious mutations), p53 can be triggered to repair the broken cell or make it self-destruct. When these incidences do not occur and genes are successfully edited, this suggests that p53 is not functioning properly in those edited cells. Since dysfunctional P53 causes significant stomach cancer risk, there are concerns that transplanting CRISPR edited cells into the body could lead to cancer. Other scientists argue that there’s no clear connection between CRISPR editing and potential cancer. For that to be true, CRISPR-edited cells intended for transplantation have to be permanently lacking in p53, which has not been established. Also, these study results are based on cultured cells, which may act differently when transplanted back into the human body.
Genomics
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June 07, 2018 – Helicobacter pylori and Prevention of Gastric Cancer

This article consists of two letters to the editor regarding a clinical trial in which the relationship between Helicobacter Pylori eradication and rate of new tumor occurrences unrelated to gastric cancer (metachronous gastric cancer) and grade of corpus atrophy was examined. In a potential trial conducted in South Korea, early gastric cancer patients who received treatment to eradicate H. pylori showed a lower rate of metachronous gastric cancer than patients in the placebo group; the patients in the treatment group also showed more improvement from baseline in the grade of corpus atrophy. Corpus atrophy was found to be more common among patients with persistent H. pylori infection than patients who had received H. pylori treatment. With regards to the recurrence of gastric cancer after eradication of H. pylori and the relationship between atrophic gastritis and metachronous gastric cancer, the authors responded that their results are not conclusive due to small sample size and number of events. The authors established that H. pylori treatment antibiotics may impact patients’ risk for other cancers and conditions but overall, H. pylori treatment should be given to early gastric cancer patients to reduce the occurrence of metachronous gastric cancer and the need for surgery.
Diagnosis and Screening
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June 3, 2018 – Increase in lifestyle-related cancers over past decade spotlights need for prevention

A recently published study found that cases of lifestyle-related cancers increased universally, while cases of cancers from infectious causes—including stomach cancers – decreased between 2006 and 2016. The 2016 rankings for the best and worst countries for stomach cancer according to number of new cases showed South Korea as the worst country with 44.5 new cases per 100,000 people and Namibia as the best country with 2.7 new cases per 100,000 people. Globally, there are 17.3 new cases for every 100,000 people. In terms of deaths, Mongolia is the worst country with 44.0 deaths per 100,000 people and Maldives is the best country with 3.2 deaths per 100,000 people. Globally, 12.6 people die in every 100,000 people.
Risk Factors
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May 29, 2018 – Gastric Cancer Screening in High-Risk Groups Cost-Effective

A new modeling study suggests that gastric-cancer screening could be cost-effective in high-risk racial and ethnic groups in the U.S. When diagnosed at an early stage, patients with gastric adenocarcinoma (GA) have a five-year survival rate of 95% to 99%. But, if detected later, the survival rate drops to less than 30%.
Thus, it is recommended for people to get screened early on. However, since the prevalence of noncardia intestinal-type gastric adenocarcinoma (NCGA) in the US is low, it is not recommended for everyone.
Results of the study showed that screening with upper endoscopy (EGD) and additional surveillance only if the test detected intestinal metaplasia (IM) or more severe pathology was cost effective for Asians Hispanics, and non-Hispanic blacks. For non-Hispanic whites, it was not cost effective.
Symptoms, Screening, & Early Detection
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