Gastric cancer : New Research – Dr. Nilesh D. Mehta
Gastric cancer ( stomach cancer) is the fifth most common cancer in the world, with nearly one million new patients diagnosed with this disease in 2012. While patients with stage IV gastric cancer remain incurable at the present time, initial treatment for advanced or recurrent gastric cancer is chemotherapy. Chemotherapy certainly has its own set of predictable side effects like bone marrow suppression, low blood counts, infection, fatigue, diarrhea, mouth sores. The addition of trastuzumab to chemotherapy provides some benefit to the group of patients with HER2-positive tumors. This is a target on the tumor cells which is being utilized to attack the cancer cells. This therapy with trastuzumab is effective for only about 15% of all gastric cancers that are HER2-positive.
At this year’s ASCO meeting in Chicago, clinical trials utilizing newer drugs to treat gastric cancer were presented. American Society of Clinical Oncology ( ASCO) is committed to making a world of difference in cancer care. As the world’s leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation.
One of the clinical research trials presented in the field of gastric cancer therapy was led by Salah-Eddin Al-Batran, MD, a medical oncologist and director at the Institute of Clinical Cancer Research, Nordwest Hospital in Frankfurt am Main, Germany. During one of the presentations, results from a European phase II study showed that the novel, first-in-class antibody IMAB362 can significantly extend median survival when added to standard chemotherapy (13.2 months vs. 8.4 months) for patients with advanced gastric cancer. This drug is a targeted agent that specifically targets a protein called claudin18.2.
Dr Salah-Eddin Al-Batran mentioned, “As claudin18.2 is abundant in gastric tumors, we estimate that half of all patients with advanced gastric cancer may be candidates for this new treatment.“ He further added that since this unique target is not present in any healthy tissues except the lining of the stomach, side effects can potentially be minimized.
A total of 161 previously untreated and HER2-negative patients with advanced or recurrent gastric or gastro-esophageal junction cancer were randomly assigned to receive chemotherapy (epirubicin, oxaliplatin, and capecitabine) alone or with IMAB362.
Compared to chemotherapy alone, IMAB362 extended the median time to disease progression from 4.8 to 7.9 months and the median overall survival from 8.4 to 13.2 months. Among the patients with the highest levels of claudin18.2, the median overall survival was 16.7 months with IMAB362 and 9 months with chemotherapy alone. While the actual numbers may seem modest, it should be noted that addition of IMAB362 does provide some excitement in the treatment of gastric cancer tumors. According to the authors, the treatment was well tolerated. Overall, rates of severe adverse effects were not increased with IMAB362 compared to chemotherapy alone.
If future trials which are being planned with this combination treatment in gastric cancer continue to show promise, this could potentially be a drug combination that would help treat advanced gastric cancer patients. Patients with HER2 positive gastric cancer can already be treated with trastuzumab. This study could lead an effort into additional targets for the treatment for gastric cancer. Treatment of cancer patients is increasingly being “target-driven” and this molecule once again represents how basic research in the laboratory can be translated into clinical advantages for our patients.