Overview of Stomach Cancer Treatments

If you have stomach (or gastric) cancer, it is natural to be wondering about the treatment options available to you. Fortunately, there are several types of gastric cancer treatments and your doctors will create a plan tailored for you. This article will provide an overview of the different types of treatments specific to gastric cancer. By learning more about these options, you can make informed decisions about your care and feel more at ease as you navigate your treatment journey. This will also help you stay on top of discussions with your cancer care team and give you an idea of what to expect.

When deciding on the best treatment options for you, your doctors will take several factors into consideration. This includes the cancer’s location within the stomach, the type and stage of gastric cancer and your overall health. This article focuses on the treatment of gastric adenocarcinomas, which are the most common type of gastric cancer. Some of these treatment types may also be applicable to other forms of gastric cancer.

Your treatment plan may involve a combination of different gastric cancer treatments, the most common of which are described below.

Surgery and other medical procedures

Doctors typically recommend surgery as part of the treatment plan. Which surgical or medical procedure you ultimately receive will depend on several factors, such as the type and stage of your gastric cancer as well as your overall health.

> Learn more about the types of surgery performed for gastric cancer

Chemotherapy

Chemotherapy is a treatment that uses drugs to stop the uncontrolled growth of cancer cells by killing the cells or preventing them from dividing.

Early stage gastric cancers are generally treated with a combination of four chemotherapeutic agents: 5-fluorouracil (5-FU), leucovorin, oxaliplatin and docetaxel. Known as the FLOT regimen, these drugs are given before and after surgery, referred to as perioperative chemotherapy. If you are due for surgery upfront, your doctors may then consider using chemotherapy after surgery (called adjuvant chemotherapy) or in conjunction with radiation therapy (known as chemoradiation) to make treatment more effective.

> Find out more about chemotherapy for gastric cancer

Radiation therapy

Radiation therapy is the use of high-power x-rays or other types of radiation to kill cancer cells or keep them from dividing. It is often used alongside chemotherapy (chemoradiation). External beam radiation therapy (EBRT), which uses a machine to direct high doses of energy beams toward the stomach, is typically used to treat gastric cancer. It does so by damaging cancer cells and shrinking gastric tumors while leaving the surrounding healthy tissue unharmed.

> Find out more about radiation therapy for gastric cancer

Targeted therapy

Cancer cells need specific genes, proteins and conditions to grow and survive. Targeted therapy uses drugs that are designed to identify and attack the cancer’s genes, proteins and tissue environment. This prevents the cancer cells from growing and spreading while limiting the damage to healthy cells. As such, this form of cancer treatment typically causes less harm to normal, healthy cells than chemotherapy or radiation therapy. Targeted therapy is typically combined with systemic chemotherapy in the treatment of advanced gastric cancer. This includes stage IV gastric cancer and cancers that come back after treatment (recurrent cancers).

When deciding whether to use targeted therapy in the treatment of gastric cancers, especially Stage IV cases, your doctors may consider two tumor markers: HER2 and Claudin18.2. Human epidermal growth factor receptor 2 (HER2) and Claudin18.2 are two proteins that are expressed at abnormally high levels in certain gastric cancers. They can be targeted by two monoclonal antibody drugs as part of targeted therapy: trastuzumab and zolbetuximab.

Trastuzumab works by targeting the HER2 protein, which can be expressed at abnormally high levels in certain gastric cancers. When used in conjunction with chemotherapy, it is a first-line treatment for HER2-positive metastatic gastric adenocarcinomas.

> Find out more about targeted therapy for gastric cancer

On the other hand, zolbetuximab is a novel drug that works by targeting the protein Claudin18.2, which is overexpressed on the surface of certain gastric cancer cells. If approved, zolbetuximab would be the first Claudin18.2-targeted therapy available in the United States for patients with advanced or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma whose tumors are HER2-negative and Claudin18.2-positive.

> Read on to find out all there is to know about zolbetuximab

Immunotherapy

Cancer cells are capable of evading your immune system by producing proteins that prevent immune system cells from recognizing them as dangerous. This makes cancer cells hard to detect. Immunotherapy interferes with this process by boosting the ability of your immune system to identify and attack these cancer cells. As such, this type of treatment uses your body’s natural defenses to fight cancer. Immunotherapy is often used to treat certain types of advanced gastric cancer.

When deciding whether to use immunotherapy in the treatment of gastric cancers, especially Stage IV cases, your doctors may consider two tumor markers: programmed death ligand 1 (PD-L1) and deficient mismatch repair (dMMR)/microsatellite instability (MSI).

Certain gastric cancers express abnormally high levels of a protein called PD-L1 on the tumor cell surface, and therefore have a high PD-L1 combined positive score (CPS) when examined during biomarker testing. Other gastric cancers are missing one or more of the mismatch repair proteins, and thus dMMR due to mutations in MMR genes, which then leads to MSI. Cancers with high MSI typically express high levels of PD-L1 as well. Gastric cancers with high PD-L1 CPS scores and/or high MS or dMMR can be treated with two immunotherapeutic agents: nivolumab or pembrolizumab. These drugs work by binding to PD-1 on the surface of gastric cancer cells, which allows immune cells to recognize and kill the cells.

> Find out more about immunotherapy for gastric cancer

Clinical Trials

Clinical trials are research studies involving people just like you. Many cancer therapies are being tested in clinical trials to see if they are safe and effective or better than the standard types of treatment. These trials can offer groundbreaking new treatments or improve current treatments for gastric cancer, providing a hopeful outcome for the future of cancer treatments.

If you are interested in taking part in cancer clinical trials, consult your doctors and care team about trials in your area that might be a good fit for you. By participating in clinical trials, you can play an active role in advancing cancer research and contribute to the development of new treatments that could potentially benefit patients like yourself.

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