Skip to main content
Top
Published in: Annals of Surgical Oncology 4/2008

Open Access 01-04-2008 | Gastrointestinal Oncology

More Controversy than Ever – Challenges and Promises Towards Personalized Treatment of Gastric Cancer

Authors: Theodore Liakakos, MD, Dimitrios H. Roukos, MD

Published in: Annals of Surgical Oncology | Issue 4/2008

Login to get access

Excerpt

Clinical decisions for the treatment of localized gastric cancer have become much more sophisticated and complicated than ever. Two recent large-scale trials published in NEJM for East Asian1 and Western patients2 strongly support the routine use of adjuvant chemotherapy. However, differences in design, extent of surgery, kind of chemotherapy timing of administration, and survival results in the two trials as well as potential differences in genetic background of Asian and Western gastric caner patients raise critical questions and grow confusion and uncertainty. Which is the optimum update treatment for Western patients? …
Literature
1.
go back to reference Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810–20PubMedCrossRef Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810–20PubMedCrossRef
2.
go back to reference Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11–20PubMedCrossRef Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11–20PubMedCrossRef
3.
go back to reference Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–730PubMedCrossRef Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–730PubMedCrossRef
4.
go back to reference Friedman A, Perrimon N. Genetic screening for signal transduction in the era of network biology. Cell 2007;128:225–31PubMedCrossRef Friedman A, Perrimon N. Genetic screening for signal transduction in the era of network biology. Cell 2007;128:225–31PubMedCrossRef
5.
go back to reference Bild AH, Potti A, Nevins JR. Linking oncogenic pathways with therapeutic opportunities. Nature Rev Canc 2006;6:735–41CrossRef Bild AH, Potti A, Nevins JR. Linking oncogenic pathways with therapeutic opportunities. Nature Rev Canc 2006;6:735–41CrossRef
6.
go back to reference Greenman C, Stephens P, Smith R, et al. Patterns of somatic mutation in human cancer genomes. Nature 2007;446:153–8PubMedCrossRef Greenman C, Stephens P, Smith R, et al. Patterns of somatic mutation in human cancer genomes. Nature 2007;446:153–8PubMedCrossRef
7.
go back to reference Thomas RK, Baker AC, Debiasi RM, et al. High-throughput oncogene mutation profiling in human cancer. Nat Genet 2007;39:347–351PubMedCrossRef Thomas RK, Baker AC, Debiasi RM, et al. High-throughput oncogene mutation profiling in human cancer. Nat Genet 2007;39:347–351PubMedCrossRef
8.
go back to reference Wood LD, Parsons DW, Jones S. The genomic landscapes of human breast and colorectal cancers. Science. 2007;318:1108–1113PubMedCrossRef Wood LD, Parsons DW, Jones S. The genomic landscapes of human breast and colorectal cancers. Science. 2007;318:1108–1113PubMedCrossRef
9.
go back to reference ENCODE Project Consortium, Birney E, Stamatoyannopoulos JA, Dutta A, et al. Identification and analysis of functional elements in 1% of the human genome by the ENCODE pilot project. Nature 2007;447:799–816PubMedCrossRef ENCODE Project Consortium, Birney E, Stamatoyannopoulos JA, Dutta A, et al. Identification and analysis of functional elements in 1% of the human genome by the ENCODE pilot project. Nature 2007;447:799–816PubMedCrossRef
11.
go back to reference Roukos DH. Innovative genomic-based model for personalized treatment of gastric cancer - integrating current standards and new technologies. Expert Rev Mol Diagn 2008;8:29–39PubMedCrossRef Roukos DH. Innovative genomic-based model for personalized treatment of gastric cancer - integrating current standards and new technologies. Expert Rev Mol Diagn 2008;8:29–39PubMedCrossRef
12.
go back to reference Roukos DH, Kappas AM. Perspectives in the treatment of gastric cancer. Nat Clin Pract Oncol 2005;2:98–107PubMedCrossRef Roukos DH, Kappas AM. Perspectives in the treatment of gastric cancer. Nat Clin Pract Oncol 2005;2:98–107PubMedCrossRef
14.
go back to reference Roukos DH. Extended lymphadenectomy in gastric cancer: when, for whom and why. Ann R Coll Surg Engl 1998;80:16–24PubMed Roukos DH. Extended lymphadenectomy in gastric cancer: when, for whom and why. Ann R Coll Surg Engl 1998;80:16–24PubMed
15.
go back to reference Roukos DH. Extended (D2) lymph node dissection for gastric cancer: do patients benefit?. Ann Surg Oncol 2000;7:253–5PubMedCrossRef Roukos DH. Extended (D2) lymph node dissection for gastric cancer: do patients benefit?. Ann Surg Oncol 2000;7:253–5PubMedCrossRef
16.
go back to reference Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005;366:2087–106PubMed Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005;366:2087–106PubMed
17.
go back to reference Punglia RS, Morrow M, Winer EP, et al. Local therapy and survival in breast cancer. N Engl J Med 2007;356:2399–405PubMedCrossRef Punglia RS, Morrow M, Winer EP, et al. Local therapy and survival in breast cancer. N Engl J Med 2007;356:2399–405PubMedCrossRef
18.
go back to reference Siewert JR, Bottcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–61PubMedCrossRef Siewert JR, Bottcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–61PubMedCrossRef
19.
20.
go back to reference Patel PR, Mansfield PF, Crane CH, et al. Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer. Cancer 2007;110:989–95PubMedCrossRef Patel PR, Mansfield PF, Crane CH, et al. Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer. Cancer 2007;110:989–95PubMedCrossRef
21.
go back to reference Roukos DH. Adjuvant chemoradiotherapy in gastric cancer: wave goodbye to extensive surgery?. Ann Surg Oncol 2002;9:220–1PubMed Roukos DH. Adjuvant chemoradiotherapy in gastric cancer: wave goodbye to extensive surgery?. Ann Surg Oncol 2002;9:220–1PubMed
22.
go back to reference Briasoulis E, Fatouros M, Roukos DH. Level I evidence in support of perioperative chemotherapy for operable gastric cancer: sufficient for wide clinical use?. Ann Surg Oncol 2007;14:2691–5PubMed Briasoulis E, Fatouros M, Roukos DH. Level I evidence in support of perioperative chemotherapy for operable gastric cancer: sufficient for wide clinical use?. Ann Surg Oncol 2007;14:2691–5PubMed
23.
go back to reference Roukos DH, Lorenz M, Karakostas K, et al. Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: a prospective with quality control 10-year follow-up study. Br J Cancer 2000;84:1602–9CrossRef Roukos DH, Lorenz M, Karakostas K, et al. Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: a prospective with quality control 10-year follow-up study. Br J Cancer 2000;84:1602–9CrossRef
24.
go back to reference Kappas AM, Fatouros M, Roukos DH. Is it time to change surgical strategy for gastric cancer in the United States?. Ann Surg Oncol 2004;11:727–30PubMedCrossRef Kappas AM, Fatouros M, Roukos DH. Is it time to change surgical strategy for gastric cancer in the United States?. Ann Surg Oncol 2004;11:727–30PubMedCrossRef
25.
go back to reference Roukos DH, Kappas AM. Targeting the optimal extent of lymph node dissection for gastric cancer. J Surg Oncol 2002;81:59–62PubMedCrossRef Roukos DH, Kappas AM. Targeting the optimal extent of lymph node dissection for gastric cancer. J Surg Oncol 2002;81:59–62PubMedCrossRef
26.
go back to reference Briasoulis E, Liakakos T, Dova L, et al. Selecting a specific pre- or postoperative adjuvant therapy for individual patients with operable gastric cancer. Expert Rev Anticancer Ther 2006;6:931–9PubMedCrossRef Briasoulis E, Liakakos T, Dova L, et al. Selecting a specific pre- or postoperative adjuvant therapy for individual patients with operable gastric cancer. Expert Rev Anticancer Ther 2006;6:931–9PubMedCrossRef
27.
go back to reference Roukos DH, Murray S, Briasoulis E. Molecular genetic tools shape a roadmap towards a more accurate prognostic prediction and personalized management of cancer. Cancer Biol Ther 2007;6:308–12PubMedCrossRef Roukos DH, Murray S, Briasoulis E. Molecular genetic tools shape a roadmap towards a more accurate prognostic prediction and personalized management of cancer. Cancer Biol Ther 2007;6:308–12PubMedCrossRef
28.
go back to reference Roukos DH. HER2 and response to paclitaxel in node-positive breast cancer. N Engl J Med 2008; 358:197, authors reply 198 Roukos DH. HER2 and response to paclitaxel in node-positive breast cancer. N Engl J Med 2008; 358:197, authors reply 198
29.
go back to reference Norton JA, Ham CM, Van Dam J, et al. CDH1 truncating mutations in the E-cadherin gene: an indication for total gastrectomy to treat hereditary diffuse gastric cancer. Ann Surg 2007;245:873–9PubMedCrossRef Norton JA, Ham CM, Van Dam J, et al. CDH1 truncating mutations in the E-cadherin gene: an indication for total gastrectomy to treat hereditary diffuse gastric cancer. Ann Surg 2007;245:873–9PubMedCrossRef
30.
go back to reference Barber M, Fitzgerald RC, Caldas C. Familial gastric cancer - aetiology and pathogenesis. Best Pract Res Clin Gastroenterol 2006;20:721–34PubMedCrossRef Barber M, Fitzgerald RC, Caldas C. Familial gastric cancer - aetiology and pathogenesis. Best Pract Res Clin Gastroenterol 2006;20:721–34PubMedCrossRef
31.
go back to reference Roukos DH, Kappas AM, Tsianos E. Role of surgery in the prophylaxis of hereditary cancer syndromes. Ann Surg Oncol 2002;9:607–609PubMedCrossRef Roukos DH, Kappas AM, Tsianos E. Role of surgery in the prophylaxis of hereditary cancer syndromes. Ann Surg Oncol 2002;9:607–609PubMedCrossRef
32.
go back to reference Chung DC, Yoon SS, Lauwers GY, Patel D. Case records of the Massachusetts General Hospital. Case 22–2007. A woman with a family history of gastric and breast cancer. N Engl J Med 2007;357:283–91PubMedCrossRef Chung DC, Yoon SS, Lauwers GY, Patel D. Case records of the Massachusetts General Hospital. Case 22–2007. A woman with a family history of gastric and breast cancer. N Engl J Med 2007;357:283–91PubMedCrossRef
33.
go back to reference Roukos DH. Prognosis of breast cancer in carriers of BRCA1 and BRCA2 mutations. N Engl J Med 2007;357:1555–6; author reply 1556PubMedCrossRef Roukos DH. Prognosis of breast cancer in carriers of BRCA1 and BRCA2 mutations. N Engl J Med 2007;357:1555–6; author reply 1556PubMedCrossRef
34.
go back to reference Roukos DH, Agnanti NJ, Paraskevaidis E, et al. Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations. Ann Surg Oncol 2002;9:941–3PubMed Roukos DH, Agnanti NJ, Paraskevaidis E, et al. Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations. Ann Surg Oncol 2002;9:941–3PubMed
35.
go back to reference Fatouros M, Baltoyiannis G, Roukos DH. The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Ann Surg Oncol 2007 Oct 17; [Epub ahead of print]; DOI: 10.1245/s10434-007-9612-4 Fatouros M, Baltoyiannis G, Roukos DH. The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Ann Surg Oncol 2007 Oct 17; [Epub ahead of print]; DOI: 10.​1245/​s10434-007-9612-4
36.
go back to reference Agnantis NJ, Paraskevaidis E, Roukos D. Preventing breast, ovarian cancer in BRCA carriers: rational of prophylactic surgery and promises of surveillance. Ann Surg Oncol 2004;11:1030–4PubMedCrossRef Agnantis NJ, Paraskevaidis E, Roukos D. Preventing breast, ovarian cancer in BRCA carriers: rational of prophylactic surgery and promises of surveillance. Ann Surg Oncol 2004;11:1030–4PubMedCrossRef
37.
go back to reference Roukos DH, Briasoulis E. Individualized preventive and therapeutic management of hereditary breast ovarian cancer. Nat Clin Pract Oncol 2007;4:578–90PubMedCrossRef Roukos DH, Briasoulis E. Individualized preventive and therapeutic management of hereditary breast ovarian cancer. Nat Clin Pract Oncol 2007;4:578–90PubMedCrossRef
39.
go back to reference Wu CW, Hsiung SA, Lo, et al. Nodal dissection for patients with gastric cancer: a randomised trial. Lancet Oncol 2006;7:309–15PubMedCrossRef Wu CW, Hsiung SA, Lo, et al. Nodal dissection for patients with gastric cancer: a randomised trial. Lancet Oncol 2006;7:309–15PubMedCrossRef
40.
go back to reference Roukos DH. Early-stage gastric cancer: a highly treatable disease. Ann Surg Oncol 2004;11:127–129PubMedCrossRef Roukos DH. Early-stage gastric cancer: a highly treatable disease. Ann Surg Oncol 2004;11:127–129PubMedCrossRef
41.
go back to reference Lee JH, Kim YW, Ryu KW, A phase-II clinical trial of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients. Ann Surg Oncol 2007 Aug 20; [Epub ahead of print] Lee JH, Kim YW, Ryu KW, A phase-II clinical trial of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients. Ann Surg Oncol 2007 Aug 20; [Epub ahead of print]
Metadata
Title
More Controversy than Ever – Challenges and Promises Towards Personalized Treatment of Gastric Cancer
Authors
Theodore Liakakos, MD
Dimitrios H. Roukos, MD
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9798-5

Other articles of this Issue 4/2008

Annals of Surgical Oncology 4/2008 Go to the issue

Hepatic and Pancreatic Tumors

Biology of Hepatocellular Carcinoma