Future perspectives of chemotherapy for advanced gastric cancer

According to the results of two recent randomized studies of treatment for metastatic gastric cancer in Japan, S-1 could replace infusional 5-fluorouracil and S-1 plus cisplatin showed a significant survival advantage over S-1 monotherapy, with a favorable toxicity profile. However, no globally accepted standards have been established yet and we have to wait for the results of other ongoing international studies, including studies of S-1 and its combinations, to achieve such standards. There are two major approaches to achieve further progress in the treatment of advanced gastric cancer. The first is to optimize the use of conventional cytotoxic agents (regimens) in the continuum of treatment for this disease. Several randomized studies of such regimens as second-line treatments are being planned in Japan, for which definitions of eligibility criteria and primary endpoints should be fully discussed in the design of the protocols. The second approach is to incorporate new active agents, particularly molecular targeting agents. Several molecular targeting agents that have shown survival advantages in patients with other tumor types are now under investigation for the treatment of gastric cancer in international randomized studies, including Japan and Korea. The next generation of targeting agents is also being evaluated in early clinical studies. Biological research has become essential for developing new targeting agents. For such biological studies, the tumor tissues of gastric cancer are easily obtainable via endoscopy, and such studies may constitute new frontiers in biological therapy. We expect that these studies will provide not only further clinical advantages but that they will also lead to tailored medicine.