Neoadjuvant Chemotherapy In Gastric Cancer:Current Status And Future Perspectives

Gastric cancer as a common gastrointestinal cancer, the incidence rate of fourth place in the world, the death rate ranked second. The mortality rate is so high, not only because of poor biological behavior of gastric cancer, the important reason is the low rate of early gastric cancer that was found, Advanced gastric cancer has become the main body of the population. The current treatment of gastric cancer has been formed to radical surgical resection,and supported by chemotherapy, radiotherapy, biological therapy, targeted therapy. In recent years,Neoadjuvant chemotherapy has been proven as an effective treatment mode, that attracted more and more attention of the medical profession.1 Gastric cancer NACT was proposed by Wilke in 1989. In2016, MAGIC published test results that confirmed the significance of the exact effect of neoadjuvant chemotherapy in gastric cancer, it was a milestone.2 There are many means for the preoperative staging of gastric,for example:CT, MRI, EUS, PET-CT, Diagnostic laparoscopy, etc. each one has its own means of inspection advantages and disadvantages.In the clinical work, we should choose efficient, accurate, anterior commissure staging means according to the patient own situation.3 For the evaluation of NACT, there are radiographic evaluation criteria and pathology evaluation criteria.4 For the time of preoperative chemotherapy and timing of surgery, it was usually controlled in 2 to 4 cycles(6 to 12 weeks), patients would be received chemotherapy efficacy evaluation after two cycles,and we should based on the efficacy results of the assessment to decide the next treatment. Recommended standard surgical is the resection of D2.5 For the drug selection of NACT, ECF regimen(epirubicin + cisplatin + 5-FU) of MAGIC Test and FP programs(5-FU + cisplatin) FFCD9703 research confirmed the exact effect of NACT. Commonly used drugs are platinum, fluorouracil, paclitaxel, etc. In the recent years, the medical profession take more attention on molecular targeted therapy of gastric cancer,the anti-HER-2 monoclonal antibody trastuzumab and the anti-vascular endothelial growth factor(VEGF) monoclonal antibody bevacizumab promote the level of gastric cancer molecular targeted therapy.