J.Jpn. Surg. Soc.. 118(6): 628-633, 2017

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Feature topic

GASTRIC CANCER

The efficacies of numerous molecular-targeting agents have been explored in gastric cancer, but the results have been rather disappointing, with only two drugs approved so far:trastuzumab, an anti-HER2 antibody to be used in the first-line setting for HER2-positive gastric cancer; and ramucirumab, a vascular endothelial growth factor-2 antibody to be used in the second-line setting for all gastric cancer patients. Neither of these drugs has been approved for use in the adjuvant or neoadjuvant setting, however, and would therefore have little influence on gastric cancer surgery. More recently, several immune-checkpoint inhibitors have emerged as promising novel domains in cancer treatment. Drugs such as the anti-PD-1 antibodies nivolumab and pembrolizumab, the anti-PD-L1 antibody avelumab, and the anti-CTLA4 antibody ipilimumab have been or are being investigated for the treatment of gastric cancer in clinical trials in several settings. These drugs reactivate T-cell functions to recognize and attack cancer cells and are expected to assist patients in overcoming the period of immunodeficiency due to surgical stress during the course of multimodality treatment. A window of opportunity presurgical trials could be proposed to identify biomarkers for predicting responses to these drugs.

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