Skip to main content

Advertisement

SpringerLink
Log in

SEOM clinical guidelines for the diagnosis and treatment of gastric adenocarcinoma

  • Clinical Guides in Oncology
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Gastric adenocarcinomas are tumours of decreasing incidence in the Western world, although they are still the fourth leading cause of cancer mortality. The purpose of these clinical guidelines is to provide recommendations for the diagnosis and treatment of this disease based on the best available evidence. Regarding resectable gastric cancer, the various potential therapeutic options are discussed (adjuvant or perioperative chemotherapy, and adjuvant or neoadjuvant chemoradiotherapy). With regard to advanced or metastatic disease, different alternative combinations of conventional cytotoxic agents including a platinum agent (cisplatin or oxaliplatin) and a fluoropyrimidine (5-FU, capecitabine or S1), with or without a third drug (epirubicin or docetaxel), as well as their integration with new biological agents (trastuzumab in HER2+ tumours), are discussed. Finally, an outline is provided of the main lines of research and development of therapies for this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parkin D, Pisani P, Ferley J et al (1999) Global cancer statistics. Ca Cancer J Clin 49:33–64

    Article  PubMed  CAS  Google Scholar 

  2. Crew KD, Neugut AI (2004) Epidemiology of upper gastrointestinal malignancies. Semin Oncol 31:450–464

    Article  PubMed  Google Scholar 

  3. Hofmann M, Stoss OR, Shi D et al (2008) Assessment of a HER2 scoring system for gastric cancer: results from a validation study. Histopathology 52:797–805

    Article  PubMed  CAS  Google Scholar 

  4. López-RÍos F, Concha A, Corominas JM et al (2011) Consenso de la Sociedad Española de AnatomÍa Patológica (SEAP) y de la Sociedad Española de Oncología Médica (SEOM) sobre la determinación de HER2 en el carcinoma gástrico. Rev Esp Patol 44:32–48

    Google Scholar 

  5. Rivera F, Carrato A, Grávalos C et al (2009) Recommendations on current approach to gastric cancer. Clin Transl Oncol 11:518–525

    Article  PubMed  Google Scholar 

  6. Okines A, Verheij M, Allum W et al (2010) On behalf of the ESMO Guidelines Working Group. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21[Suppl 5]:v50–v54

    Article  PubMed  Google Scholar 

  7. GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, Burzykowski T et al (2010) Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 303:1729–1737

    Article  PubMed  CAS  Google Scholar 

  8. Sakuramoto S, Sasako M, Yamaguchi T et al; ACTS-GC Group (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  PubMed  CAS  Google Scholar 

  9. Bang Y, Kim YW, Yang H et al (2011) Adjuvant capecitabine and oxaliplatin for gastric cancer: results of the phase III CLASSIC trial. J Clin Oncol 29:[Suppl]:abstr LBA4002

    Google Scholar 

  10. Macdonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730

    Article  PubMed  CAS  Google Scholar 

  11. Macdonald JS, Smalley S, Benedetti J et al (2004) Postoperative combined radiation and chemotherapy improves disease-free survival (DFS) and overall survival (OS) in resected adenocarcinoma of the stomach and gastroesophageal junction: update of the results of Intergroup Study INT-0116 (SWOG 9008). ASCO (abstr #6)

    Google Scholar 

  12. Fuchs CS, Tepper JE, Niedzwiecki D et al (2011) Postoperative adjuvant chemoradiation for gastric or gastroesophageal junction (GEJ) adenocarcinoma using epirubicin, cisplatin, and infusional (CI) 5-FU (ECF) before and after CI 5-FU and radiotherapy (CRT) compared with bolus 5-FU/ LV before and after CRT: intergroup trial CALGB 80101. J Clin Oncol 29[Suppl]:abstr 4003

    Google Scholar 

  13. Lee J, Lim do H, Kim S et al (2012) 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 30:268–273

    Article  PubMed  CAS  Google Scholar 

  14. Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for respectable gastroesophageal cancer. N Engl J Med 355:11–20

    Article  PubMed  CAS  Google Scholar 

  15. Boige V, Pignon J, Saint-Aubert B et al (2007) Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. J Clin Oncol 25[18s]:Abst 4510

    Google Scholar 

  16. Schuhmacher C, Schlag P, Lordick F et al (2009) Neoadjuvant chemotherapy versus surgery alone for locally advanced adenocarcinoma of the stomach and cardia: randomized EORTC phase III trial #40954. J Clin Oncol 27[15s]:Abstr 4510

    Google Scholar 

  17. Stahl M, Walz MK, Stuschke M et al (2009) Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27:851–856

    Article  PubMed  CAS  Google Scholar 

  18. Wagner AD, Grothe W, Haerting J et al (2006) Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 24:2903–2909

    Article  PubMed  CAS  Google Scholar 

  19. Sastre J, García-Saenz JA, Díaz-Rubio E (2006) Chemotherapy for gastric cancer. World J Gastroenterol 12:2004–2213

    Google Scholar 

  20. Van Cutsem E, Moiseyenko VM, Tjulandin S et al (2006) 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 24:4991–4997

    Article  PubMed  Google Scholar 

  21. Cunningham D, Starling N, Rao S et al (2008) Upper Gastrointestinal Clinical Studies Group of the National Cancer Research Institute of the United Kingdom: capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358:36–46

    Article  PubMed  CAS  Google Scholar 

  22. Al-Batran SE, Hartmann JT, Probst S et al (2008) 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 26:1435–1442

    Article  PubMed  CAS  Google Scholar 

  23. Kang AND, Kang WK, Shin DB et al (2009) Capecitabine/cisplatin versus 5-fluorouracil/ cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III non inferiority trial. Ann Oncol 20:666–673

    Article  PubMed  Google Scholar 

  24. Okines AF, Norman AR, McCloud P et al (2009) Meta-analysis of the REAL-2 and ML17032 trials: evaluating capecitabine-based combination chemotherapy and infused 5-fluorouracil-based combination chemotherapy for the treatment of advanced oesophago-gastric cancer. Ann Oncol 20:1529–1534

    Article  PubMed  CAS  Google Scholar 

  25. Ajani JA, Rodriguez W, Bodoky G et al (2010) Multicenter phase III comparison of cisplatin/S-1 with cisplatin/infusional fluorouracil in advanced gastric or gastroesophageal adenocarcinoma study: the FLAGS trial. J Clin Oncol 28:1547–1553

    Article  PubMed  CAS  Google Scholar 

  26. Dank M, Zaluski J, Barone C et al (2008) 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 19:1450–1457

    Article  PubMed  CAS  Google Scholar 

  27. Gravalos C, Jimeno A (2008) HER2 in gastric cancer: a new prognostic factor and a novel therapeutic target. Ann Oncol 19:1523–1529

    Article  PubMed  CAS  Google Scholar 

  28. Gravalos C, Marquez A, GarcÍa-Carbonero R et al (2007) Correlation between Her2/neu overexpression/ amplification and clinicopathological parameters in advanced gastric cancer patients: a prospective study. Gastrointestinal Cancers Symposium 130:Abstr 89

    Google Scholar 

  29. Gravalos C, Gomez-Martin C, Rivera F et al (2011) Phase II study of trastuzumab and cisplatin as first-line therapy in patients with HER2-positive advanced gastric or gastroesophageal junction cancer. Clin Transl Oncol 13:179–184

    Article  PubMed  CAS  Google Scholar 

  30. Bang YJ, Van Cutsem E, Feyereislova A et al (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastrooesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376:687–697

    Article  PubMed  CAS  Google Scholar 

  31. van Cutsem E, Shah M, Kang AND et al (2010) Randomized, double-blind, placebo-controlled, multicentre phase III study of capecitabine/cisplatin + bevacizumab (bev) or placebo (pl) as 1st-line therapy in patients (pts) with advanced gastric cancer (AGC) (AVAGAST update). ESMO Abst 713 P

    Google Scholar 

  32. Rao S, Starling N, Cunningham D et al (2010) Matuzumab plus epirubicin, cisplatin and capecitabin (ECX) compared with epirubicin, cisplatin and capecitabine alone as first-line treatment in patients with advanced oesophago-gastric cancer: a randomised, multicentre open-label phase II trial. Ann Oncol 21:2213–2219

    Article  PubMed  CAS  Google Scholar 

  33. Thuss-Patience PC, Kretzschmar A, Deist T et al (2009) 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 27(18s):Abstr 4540

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla, s/n, ES-39008, Santander, Spain

    Fernando Rivera

  2. Servicio de Oncología Médica, Hospital Universitario 12 de octubre, Madrid, Spain

    Cristina Grávalos

  3. Servicio de Oncología Médica, Hospital Universitario Virgen del RocÍo, Sevilla, Spain

    Rocío García-Carbonero

Authors
  1. Fernando Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Grávalos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rocío García-Carbonero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Rivera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rivera, F., Grávalos, C. & García-Carbonero, R. SEOM clinical guidelines for the diagnosis and treatment of gastric adenocarcinoma. Clin Transl Oncol 14, 528–535 (2012). https://doi.org/10.1007/s12094-012-0836-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-012-0836-9

Keywords

Search

Navigation