Advanced gastric cancer: is there an optimal chemotherapy regimen?

ABSTRACT Introduction: Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-related death worldwide. For patients with advanced gastric cancer (AGC), systemic chemotherapy remains the standard of care, improving survival and quality of life (QoL); however prognosis remains poor. Areas covered: Several clinical trials have been evaluated the efficacy of different combination regimens in AGC patients. This review will underline existing literature on the role of chemotherapy in the management of AGC, discussing the key determinants of treatment decision aiming at identify the optimal chemotherapy regimen for individual patients and the role of addition of biological agents in these regimens. Expert commentary: Despite the progress in understanding of the molecular subtypes of GC, chemotherapy remains the backbone of treatment for all-line setting in well-selected AGC patients. Moreover, several trials have failed to demonstrate a benefit of targeted agents and to date only trastuzumab and ramucirumab and apatinib only in China are approved in the treatment of this disease. Therefore, an improved patient selection before and during therapy with a better definition of predictive biomarkers are really needed.