Gastric cancer, or stomach cancer, is a major global health concern, ranking as one of the leading causes of cancer-related deaths worldwide. The treatment landscape for gastric cancer has undergone a significant evolution, with chemotherapy playing a pivotal role in improving patient outcomes. This blog aims to enlighten you about the remarkable advancements in chemotherapy for gastric cancer, focusing on the development and impact of specific chemotherapy agents.

What is gastric cancer?

Gastric cancer originates in the lining of the stomach and can spread to other parts of the body. Early detection is challenging due to the often asymptomatic nature of the disease in its initial stages. Consequently, many patients are diagnosed at an advanced stage, where surgical options may be limited. Chemotherapy has emerged as a vital treatment modality, either as a standalone therapy or in combination with surgery and radiation.

What chemotherapy is used for gastric cancer?

Historically, several chemotherapy agents have been used to treat gastric cancer. These include:

• Fluorouracil (5-FU): A cornerstone in gastric cancer treatment, 5-FU inhibits the synthesis of DNA and RNA, thereby preventing cancer cell replication.
• Cisplatin: Cisplatin, often used in combination with other medications, interferes with DNA replication and transcription in cancer cells.
• Doxorubicin: This medication intercalates DNA, disrupting essential processes within cancer cells and leading to cell death.

What is S-1 chemotherapy?

One significant advancement in gastric cancer chemotherapy is the development of S-1, an oral chemotherapy agent. S-1 combines three compounds: Tegafur, Gimeracil, and Oteracil. Each component plays a unique role in enhancing the medication's effectiveness and reducing side effects.

• Tegafur: This is a prodrug of 5-FU, meaning it is converted into 5-FU in the body, providing a sustained release of the active medication.
• Gimeracil: This compound inhibits the enzyme dihydropyrimidine dehydrogenase (DPD), which breaks down 5-FU. By inhibiting DPD, Gimeracil increases the bioavailability and efficacy of 5-FU.
• Oteracil: This component reduces the gastrointestinal toxicity associated with 5-FU, allowing higher doses to be administered safely.

S-1 chemotherapy has shown promise in clinical trials, demonstrating improved survival rates and better tolerance compared to traditional intravenous 5-FU. However, like any chemotherapy, S-1 can cause side effects such as nausea, vomiting, and fatigue. It's important for patients to discuss these potential side effects with their healthcare team and to report any symptoms they experience during treatment.

Tegonat 20mg Capsule is another important addition to the chemotherapy arsenal for gastric cancer. This medication, is a combination of Tegafur, Gimercail, and Oteracil. Its development aims to provide the benefits of 5-FU with more convenient administration and potentially fewer side effects. Tegonat 20mg Capsule is often used in combination with other chemotherapy agents to enhance its effectiveness.

What are the latest treatments for gastric cancer?

The evolution of chemotherapy in gastric cancer care involves not only the development of new medications but also the refinement of treatment protocols. Combination chemotherapy, where multiple medications are used together, has become a standard approach. This strategy aims to target cancer cells through different mechanisms, increasing the likelihood of treatment success and reducing the risk of medication resistance.

When to give neoadjuvant chemotherapy?

Neoadjuvant chemotherapy, administered before surgery, holds the potential to shrink tumours, making them easier to remove surgically. This approach also targets micrometastases that may not be detectable but could lead to recurrence. Studies have shown that neoadjuvant chemotherapy can significantly improve surgical outcomes and overall survival in gastric cancer patients, offering a ray of hope for the future.

Adjuvant chemotherapy, given after surgery, aims to eliminate any remaining cancer cells and reduce the risk of recurrence. The combination of surgery and adjuvant chemotherapy has become a standard treatment protocol for advanced gastric cancer.

Is immunotherapy effective for gastric cancer?

In addition to traditional chemotherapy, the treatment landscape for gastric cancer is being transformed by the advent of targeted therapies and immunotherapy. These innovative approaches focus on specific molecular changes within cancer cells and harness the body's immune system to fight cancer, offering a more comprehensive and precise approach to treatment. 

• HER2-Targeted Therapy: Approximately 20% of gastric cancers overexpress the HER2 protein. Trastuzumab, a monoclonal antibody, targets HER2 and has been shown to improve survival in HER2-positive gastric cancer patients.
• VEGF Inhibitors: Medications like bevacizumab target vascular endothelial growth factor (VEGF), which promotes blood vessel growth in tumours. By inhibiting VEGF, these medications can reduce tumour blood supply and growth.

Immunotherapy, which harnesses the body's immune system to fight cancer, has also shown promise in gastric cancer treatment. Immune checkpoint inhibitors, such as pembrolizumab, block proteins that prevent immune cells from attacking cancer cells. This approach can enhance the body's natural immune response against cancer.

Does gastric cancer have lifelong effects?

The future of gastric cancer chemotherapy lies in personalised medicine. Advances in genomic and molecular profiling allow for the identification of specific biomarkers that can predict a patient's response to certain treatments. This approach enables oncologists to tailor chemotherapy regimens to individual patients, optimising efficacy and minimising side effects.