胃癌治疗方案的临床管理。

Juliette Boilève, Yann Touchefeu, Tamara Matysiak-Budnik
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引用次数: 0

摘要

胃癌是全球第五大常见癌症,也是癌症相关死亡的第四大原因。对于极早期胃癌的特定病例,可采用内镜下切除术进行治疗。对于不符合内镜切除标准的肿瘤或有淋巴结侵犯但无远处转移的肿瘤,建议采用手术治疗。胃切除术应包括 D2 淋巴腺切除术,但不包括脾切除术。围手术期或辅助化疗可提高生存率,推荐用于局部晚期胃癌(>T1 和/或淋巴结阳性)。对于微卫星不稳定(MSI)的局部晚期癌症,应考虑采用免疫疗法。无法切除或转移的晚期胃癌预后较差。治疗的基础是细胞毒性化疗,第一线是铂类和氟嘧啶类双联疗法。靶向疗法可与化疗相结合。对于 HER2 阳性的癌症,建议一线使用曲妥珠单抗(抗 HER2)。建议在紫杉醇化疗的基础上,在二线使用 Ramucirumab(抗血管内皮生长因子受体 2)。对于 Claudine 18.2 阳性的癌症,在一线治疗中也应考虑使用 Zolbetuximab(抗 Claudine 18.2)。免疫疗法也可与化疗联合用于 PD-L1 阳性癌症的一线治疗。对于 HER2 阳性和 PD-L1 阳性的癌症,应考虑曲妥珠单抗与免疫疗法联合使用。对于伴有微卫星不稳定性(MSI)的晚期和转移性癌症,应根据免疫疗法的可用性将其作为首选。近年来,胃癌的治疗取得了重大进展,这主要归功于人们对胃癌的分子特征和异质性有了更深入的了解。目前正在开发新的靶点和治疗方法,这很可能会改变胃癌的治疗方法。
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Clinical Management of Gastric Cancer Treatment Regimens.

Gastric cancer is the fifth most common cancer and the fourth leading cause of cancer-associated death in the world. Endoscopic resection can be the treatment in selected cases of very early gastric cancer. Surgery is recommended for tumors that do not meet the criteria for endoscopic resection or for tumors with lymph node invasion but without distant metastases. Gastrectomy should include D2 lymphadenectomy without splenectomy. Perioperative or adjuvant chemotherapy improves survival and is recommended in locally advanced gastric cancer (>T1 and/or with lymph nodes positive). In locally advanced cancer with microsatellite instability (MSI), immunotherapy should be considered. Advanced unresectable or metastatic gastric cancer has a poor prognosis. The basis of the treatment is cytotoxic chemotherapy, with platinum and fluoropyrimidine doublet in the first line. Targeted therapies can be combined with chemotherapy. Trastuzumab (anti-HER2) is recommended in the first line in HER2-positive cancer. Ramucirumab (anti-VEGFR2) is recommended in the second line, in addition to paclitaxel chemotherapy. Zolbetuximab (anti-Claudine 18.2) should also be considered in the first line in Claudine 18.2-positive cancer. Immunotherapy can also be associated with chemotherapy in the first line of PD-L1-positive cancer. In HER2-positive and PD-L1-positive cancer, adjunction of trastuzumab and immunotherapy should be considered. In advanced and metastatic cancer with microsatellite instability (MSI), immunotherapy should be the first choice depending on its availability. Important progress has been made in recent years in the treatment of gastric cancer, especially due to a better understanding of molecular characteristics and heterogeneity of this disease. New targets and therapeutic approaches are being developed, which will very likely lead to changes in the management of gastric cancer.

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来源期刊
CiteScore
5.60
自引率
0.00%
发文量
26
审稿时长
>12 weeks
期刊介绍: The review series Current Topics in Microbiology and Immunology provides a synthesis of the latest research findings in the areas of molecular immunology, bacteriology and virology. Each timely volume contains a wealth of information on the featured subject. This review series is designed to provide access to up-to-date, often previously unpublished information.
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