Understanding Your Treatment Path
- To treat advanced gastric cancer, oncologists typically use systemic therapies. These are treatments that affect the entire body, and they fall into three major categories: chemotherapy, immunotherapy, and targeted therapy.
- The treatment aims to slow disease progression, relieve symptoms, improve quality of life, and extend survival.
- New treatments are being developed all the time with constant improvement and better outcomes.
- When selecting the appropriate treatment category, the oncology team carefully considers key factors such as the type of tumor histology, biomarker expression, and previous treatments the patient has undergone.
It’s important to emphasize that effective treatments are still available for advanced stages of gastric cancer. Improvements in oncology have led to the development of several systemic therapies — or therapies that treat the whole body — which can be offered safely to these patients, often with promising results.
Read MoreCurrent Treatment Options
All patients with newly diagnosed advanced gastric should have a full assessment of symptom burden, nutritional and psychological status, and social supports as early as possible, ideally before starting systemic chemotherapy. To treat advanced gastric cancer, oncologists use systemic therapies. These are treatments that affect the entire body, and they fall into three major categories: chemotherapy, immunotherapy, and targeted therapy.When selecting the appropriate treatment category, the oncology team carefully considers key factors such as the type of tumor histology, biomarker expression, and previous treatments the patient has undergone. Importantly, before initiating any treatment, the patient’s overall health status is essential, as chemotherapy and other treatments can be physically demanding.
The investigation for biomarker expression will guide the therapy.
In this context, the most common biomarkers are mismatch repair deficiency (dMMR) and high levels of microsatellite instability (dMMR/MSI-H), PD-L1 expression, and human epidermal growth factor receptor 2 (HER2) over-expression and/or gene amplification. Make sure to ask your doctor about testing for the expression of a protein called Claudin 18.2. Testing for Claudin 18.2 is a crucial step in determining whether a medication called Vyloy will be an effective treatment option. The drug has been approved for certain patients with locally advanced or metastatic gastric cancer.
“We now use biomarkers to help guide treatment,” Dr. Hornstein explains. “These biomarkers tell us if a patient might benefit from targeted therapies, like trastuzumab for HER2-positive tumors or pembrolizumab, an anti-PD-L1 therapy, for tumors that express certain proteins.”
The Treatment Arsenal — What’s Available?
Chemotherapy
Systemic therapy for advanced gastric cancer involves treatments that work throughout the body to target cancer cells, including those that may have spread beyond the stomach. This approach typically includes chemotherapy, which uses drugs to kill or slow the growth of cancer cells and may also involve targeted therapies, which are drugs that specifically attack cancer cells with certain markers, sparing more healthy cells.
“In chemotherapy, we often use a drug called 5-FU, or sometimes its oral form, capecitabine. These are often combined with platinum-based drugs like oxaliplatin or cisplatin,” Dr. Hornstein explains.
Chemo drugs attack cells in the body that are dividing quickly, which can lead to side effects. The side effects depend on the type and dose of drugs, as well as the length of treatment.
Some common side effects include:
- Nausea
- Vomiting
- Loss of appetite
- Hair loss
- Diarrhea
- Constipation
Radiation Therapy
Radiation therapy is a type of cancer treatment that uses high-energy rays, like X-rays, to target and destroy cancer cells. It works by damaging the DNA inside the cancer cells, which stops them from growing and spreading. Radiation therapy is usually directed at a specific area of the body where the cancer is located to minimize harm to nearby healthy tissue. It can be used on its own or combined with other treatments, like surgery or chemotherapy, to help control or shrink the cancer and relieve symptoms.
For cancers that can’t be removed with surgery, radiation therapy can help slow the cancer’s growth and reduce symptoms like pain, bleeding, or trouble eating. Radiation can also be employed as an effective strategy in addition to chemotherapy and surgery, in cancers like esophageal or rectal cancer.
Immunotherapy
A key function of the immune system is its ability to distinguish and avoid attacking the body’s own healthy cells. It achieves this by using “checkpoint” proteins on immune cells, which work like switches that must be activated or deactivated to initiate an immune response. Cancer cells, however, sometimes exploit these checkpoints to evade immune detection.
To counter this, certain drugs known as immune checkpoint inhibitors target these checkpoints and can be effective in treating some patients with stomach cancer. As an example of this option are the currently approved drugs, nivolumab (Opdivo) and pembrolizumab (Keytruda) — drugs that target PD-1, a protein on immune system cells called T cells.
Some patients may experience infusion reactions, similar to allergic responses, when receiving these drugs, with symptoms like fever, chills, skin flushing, rash, itching, dizziness, wheezing, and breathing difficulty. Additionally, since these drugs lift certain immune system safeguards, they may trigger autoimmune reactions; it’s essential to report these to a healthcare provider immediately for any adverse effects.
“There are new treatments being developed all the time, like zolbetuximab (VYLOY) for tumors expressing a protein called CLDN18.2. This is an exciting, rapidly changing field, and we’re learning more about how to treat advanced gastric cancer every month,” Dr. Hornstein adds.
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