Stomaco/Stomach (C16.9) - Trattamento medico del carcinoma gastrico metastatico / Medical treatment of metastatic gastric cancer
Keywords:
Carcinoma gastrico, chemioterapia, terapia biologica, Gastric cancer, chemotherapy, biologic therapyAbstract
Finalità. Identificare regimi chemioterapici ingrado di determinare un alto tasso di risposte ed un prolungamento della sopravvivenza nel paziente con carcinoma gastrico metastatico. Materiali e metodi. È stata eseguita una revisione della letteratura concernente l’utilizzo di regimi contenenti Oxaliplatino (O), Capecitabina (X) o Docetaxel (D). Infine è stata posta attenzione all’utilizzo di Trastuzumab (T) nei pazienti con malattia metastatica HER2 3+ (ToGA Trial). Risultati. Recenti studi hanno dimostrato pari efficacia nell’utilizzo della X in sostituzione del 5-Fluorouracile (F) e dell’O rispetto al Cisplatino (C). L’associazione EOX ha mostrato un elevato response rate (RR) associato ad un profilo di tossicità accettabile, ed è da considerare come uno degli standard terapeutici. L’aggiunta del Docetaxel (D) alla doppietta CF determina un incremento del RR e del time-to-progression (TTP), a fronte di un aumento della tossicità ematologica. Nel complesso, anche la tripletta DOX potrebbe essere proposta come valida combinazione di prima linea. Uno studio di fase III ha dimostrato un incremento dell’overall survival (OS), della progression free survival (PFS) e del RR in pazienti con HER-2 overespresso trattati con T in associazione a chemioterapia (CF). Conclusioni. I risultati osservati dimostrano un’equivalenza di efficacia nell’utilizzo dell’Oxaliplatino (O) rispetto al Cisplatino (C) e della Capecitabina (X) rispetto al 5-Fluorouracile (F), con un miglior profilo di tossicità. L’utilizzo di uno schema a 3 farmaci contenente Docetaxel (DOX) potrebbe essere una valida alternativa. Alla luce dei dati dello studio ToGA, ai fini di un’adeguata scelta terapeutica risulta mandatorio valutare l’overespressione di HER2.Medical treatment of metastatic gastric cancer
Purpose: To identify chemotherapy regimens able to determine an high response rate and increase time to progression in metastatic gastric cancer patients. Materials and methods:We reviewed the literature about chemotherapy regimens with Oxaliplatin (O), Capecitabine (X) or Docetaxel (D), with a special interest to Trastuzumab (T) in HER-2 positive metastatic disease (ToGA Trial). Results: Recent studies have demonstrated same efficacy for X as a substitute for 5-Fluorouracil (F) and O compared to Cisplatin (C). The regimen containing anthracyclines (EOX) showed a high response rate (RR) with a reasonable toxicity and it is currently one of the gold standard regimens. The addition of D to the CF regimen determines an higher RR and time to progression (TTP), but it also causes an higher hematologic toxicity. On the whole, the DOX regimen could represent a valid combination for first line chemotherapy. A phase III study has shown an increase in overall survival (OS), progression free survival (PFS) and RR in patients with HER-2 positive disease treated with T in combination with chemotherapy (CF). Conclusion: The results from different studies show the same efficacy using O instead of C and X instead of F, with a lighter toxicity. The addition of Docetaxel to this regimen (DOX) could represent an efficient choice. After the results of the ToGA trial, the overexpression of HER-2 must be evaluated in order to give the best treatment to the patient.
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