Gastric Cancer

Question 1

Preoperative Chemoradiation

• Infusional 5-FU can be replaced with capecitabine

Answer 1

• Preferred Regimens:
Paclitaxel and carboplatin (category 1)
Fluorouracil and cisplatin (category 1)
Fluorouracil and oxaliplatin (category 1)

• Other Regimens:
Paclitaxel and fluoropyrimidine (fluorouracil or capecitabine) (category 2B

Question 2

Perioperative Chemotherapy

3 cycles preoperative and 3 cycles postoperative

Answer 2

• Fluorouracil and cisplatin (category 1)
• ECF (epirubicin, cisplatin, and fluorouracil) (category 2B)
• ECF modifications (category 2B)
Epirubicin, oxaliplatin, and fluorouracil
Epirubicin, cisplatin, and capecitabine
Epirubicin, oxaliplatin, and capecitabine

Question 3

Postoperative Chemoradiation

Answer 3

• Fluoropyrimidine (infusional fluorouracil or capecitabine) before and after fluoropyrimidine-based chemoradiation

Question 4

Postoperative Chemotherapy

for patients who have undergone primary D2 lymph node dissection

Answer 4

• Capecitabine and oxaliplatin

* Capecitabine and cisplatin

Question 5

Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated)

Answer 5

• Trastuzumab should be added to first-line chemotherapy for HER2-neu overexpressing metastatic adenocarcinoma
Combination with fluoropyrimidine and cisplatin (category 1)
Combination with other chemotherapy agents (category 2B)
Trastuzumab is not recommended for use with anthracyclines

Question 6

Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated)
First-Line Therapy

Answer 6

Two-drug cytotoxic regimens are preferred because of lower toxicity.
Three-drug cytotoxic regimens should be reserved for medically fit patients with good PS and access to frequent toxicity evaluation.

• Preferred Regimens:
Fluoropyrimidine (fluorouracil or capecitabine) and cisplatin (category 1)
Fluoropyrimidine (fluorouracil or capecitabine) and oxaliplatin

• Other Regimens:
Paclitaxel with cisplatin or carboplatin
Docetaxel with cisplatin
Fluoropyrimidine (fluorouracil or capecitabine) Docetaxel
Paclitaxel
Fluorouracil and irinotecan (category 1)
DCF modifications
◊ Docetaxel, cisplatin, and fluorouracil
◊ Docetaxel, oxaliplatin, and fluorouracil
◊ Docetaxel, carboplatin, and fluorouracil (category 2B)
ECF (epirubicin, cisplatin, and fluorouracil) (category 1)
ECF modifications (category 1)
◊ Epirubicin, oxaliplatin, and fluorouracil
◊ Epirubicin, cisplatin, and capecitabine
◊ Epirubicin, oxaliplatin, and capecitabine

Question 7

Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated)
Second-Line Therapy
Dependent on prior therapy and PS:

Answer 7

• Preferred Regimens: 
Ramucirumab and paclitaxel (category 1)
Docetaxel (category 1)
Paclitaxel (category 1)
Irinotecan (category 1)
Ramucirumab (category 1)

• Other Regimens:
Irinotecan and cisplatin
Fluoropyrimidine (fluorouracil or capecitabine) and irinotecan(category 2B)
Docetaxel and irinotecan45 (category 2B)