Gastric Cancer pp 173-180 | Cite as

Gastric Cancer: Chemotherapy for Advanced Disease with Special Focus on Studies from Japan

  • Taroh SatohEmail author


Unresectable or metastatic advanced gastric cancer (AGC) is non-curable, and median survival time (MST) is about 3 months when best supportive care (BSC) is performed. By chemotherapy, MST has been extended to about 13–14 months, and symptomatic relief can be expected by high tumor shrinkage effect (Murad et al., Cancer 72:37–41, 1993).

In the primary treatment, the standard treatment was decided internationally as a combination therapy of pushed pyrimidine and platinum, and treatment strategy was individualized by expression of HER2 protein. In second-line treatment, weekly paclitaxel (PTX) + ramucirumab (RAM) therapy is considered as standard. For third-line therapy, the survival prolonging effect of immune checkpoint inhibitors, which is attracting attention in many types of cancer in recent years, was also observed in gastric cancer. Nivolumab has shown significant survival extension effect in salvage line study. Thus, in recent years, standardization of treatment strategies and individualization based on biomarkers have been in progress, and further approval of new agents is expected to extend overall survival. On the other hand, treatment for the elderly and patients with severe peritoneal metastasis, which are not eligible to receive standard treatment, has not been established and is a future clinical problem. In this chapter, we discuss about treatment strategies and prospects for unresectable/recurrent gastric cancer.


Chemotherapy for advanced gastric cancer S-1 Capecitabine Ramcirumab Nivolumab 


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Frontier Science for Cancer and ChemotherapyOsaka University Graduate School of MedicineSuitaJapan

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