Chemotherapy for Advanced Unresectable Gastric Cancer

Older-generation regimens against advanced gastric cancer have limited efficacy. No standard regimens worldwide, as well as in Japan, have been established yet, and a limited number of patients have achieved objective response and long-term survival. However, some of the new-generation regimens improved response rate more than 50% and suggested survival prolongation in the preliminary studies. These treatments are being investigated in ongoing randomized studies in Japan, and we should wait for the results to confirm these improvements. Recent development of molecular technology has produced various types of molecular targeting agents. These agents are the other new hopes for improving efficacy results with less toxicity than classic cytotoxic agents. Understanding the biology of gastric cancer may result in better targets or cellular pathways to be modified or blocked by therapeutic interventions. Additionally, improvement of the clinical trial design and molecular surrogate in clinical research will lead to the development of better treatments. Both clinical and biology research will be more important.