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The Role of Chemotherapy in Metastatic Disease

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Surgery in the Multimodal Management of Gastric Cancer

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Abstract

In the setting of metastatic or inoperable gastric cancer, chemotherapy has improved survival over that achieved with best supportive care. Randomized phase III trials showed better outcome for cisplatin-containing schedules, and in Western countries ECF is widely accepted as the reference regimen. Median survival in those studies was essentially < 1 year. However, recent phase III studies, also using new drugs, such as docetaxel, oxaliplatin, irinotecan, capecitabine, and S1, have likewise failed to demonstrate a major improvement. Promising data have been recently published for trastuzumab-containing therapy. In the 20–50% patients receiving 2nd-line chemotherapy, the results have been disappointing and survival is only 6–8 months. Thus, despite small signs of progress, metastatic gastric cancer remains an incurable disease and treatment should primarily consider the patient’s quality of life. The best hope for the future is based on tailored interventions with new cytotoxic drugs, targeted therapies, and the integration of molecular determinants.

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  1. Dept. of Medical Oncology, “Santa Maria della Misericordia” Hospital, Rovigo, Italy

    Felice Pasini

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  1. Felice Pasini
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  2. Anna Paola Fraccon
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  3. Giorgio Crepaldi
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  4. Giovanni de Manzoni
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  1. Dept. of Surgery Upper G.I. Surgery Division, University of Verona, Verona, Italy

    Giovanni de Manzoni

  2. Dept. of Human Pathology and Oncology Section of General Surgery and Surgical Oncology Translational Research Laboratory, University of Siena, Siena, Italy

    Franco Roviello

  3. Surgical Clinic, Dept. of Medical and Surgical Sciences “Ospedali Riuniti” University Hospital, Polytechnic University of Marche, Ancona, Italy

    Walter Siquini

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Pasini, F., Fraccon, A.P., Crepaldi, G., de Manzoni, G. (2012). The Role of Chemotherapy in Metastatic Disease. In: de Manzoni, G., Roviello, F., Siquini, W. (eds) Surgery in the Multimodal Management of Gastric Cancer. Springer, Milano. https://doi.org/10.1007/978-88-470-2318-5_23

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