Can We Understand the Clinical Biology of Gastric Cancer and Exploit it? May be, but It is a Challenge!

Excerpt

Gastric cancer remains a significant health problem worldwide,1 and yet the progress has been much slower against gastric cancer than against other cancers (colon, breast, lung, and prostate); however, the other cancers are more common in the West. Reasons for this discrepancy are many, but it is clear that if a cancer type is common in the West, it gets attention from the pharmaceutical companies and the U.S. Government. Our approach to localized gastric cancer has been typical of that for many other localized cancers; that is, we attempt a good clinical staging process and treat all defined stages similarly (empiricism). Whether we use preoperative therapy, surgery, or postoperative adjuvant therapy, one thing is certain: all patients with >T1 cancers when offered uniform therapy end up with diverse outcomes. Without much insight, we simply follow our patients to see who survives and who dies. We also witness unpredictable and sometime extraordinary toxicities (complications) experienced by our patients. The question is how can we possibly get out of this modus operandi? Recent molecular studies have demonstrated surprising intertumoral molecular heterogeneity that was unexpected, creating even more challenges than we thought previously.2 In gastric cancer, our limited knowledge restricts us even further, but it may be time to face that challenge. …