of Stefano Cascinu
Achieving the possible goal if early diagnosis and operable neoplasm, but important progress has also been made for patients with metastases
My wife, aged 57, was diagnosed with stomach cancer. It seems operable. I read on the Internet that the chance of recovery is very limited and the 5-year survival is only 30%. I hope it can calm me down a little.
He answers Stefano Cascinu, director of the Comprehensive Cancer Center and of the Medical Oncology of the IRCCS San Raffaele Hospital in Milan
I understand your concern, especially about what you can read on the Internet. Obviously his wife will have had a CT scan and if everything is negative, as I hope, surgery may be preceded by chemotherapy. In that case, after 4 administrations, his wife will have to repeat the CT scan and, if the situation is at least stable, she will be operated on. After about 8 weeks, resume therapy for another 4 cycles. With this therapy approach, called perioperative, About 25 out of 100 patients increase their chance of recovery compared to surgery alone. In stomach cancer, however, these advances have not only occurred in the operable forms, but also in the more advanced ones.
Progress also for patients with metastases
For a patient with metastatic disease until a few years ago the possibility of life was more or less than 6/8 months. Treatment was limited to 5Fluorouracil chemotherapy, which was also the only possible line. If it didn’t work, they moved on to palliative care. In a few years the picture has changed thanks to both a better biological knowledge of the tumor and the availability of new drugs. Thanks to the evidence that about 15% of patients with stomach cancer have an alteration in one receptor, HER-2, similar to what is present in breast cancer, the trastuzumab, anti-HER2 drug, has also been used in this disease. Of course only for a minority of patients, but it can triple their chances of survival. However, what has changed the life chances of many patients is having multiple lines of therapy: when a first line fails, a second line can be offered. The most used scheme sees the combination of paclitaxel, a typical chemotherapy, with the ramucirumab, a drug against cancer blood vessels. Patients who receive this combination double their chance of life and also have a noticeable improvement in the quality of life.
Third line of therapy available and experimental treatments
Finally, more recently we can offer patients too a third line of therapy. Indeed, trifluridina tipiracil, oral drug, already used in colorectal cancer, has shown in a study that it is capable of doubling the possibility of life of patients and slowing down the worsening of the general conditions due to the disease. Unfortunately, this drug is not yet available in Italy as the Medicines Agency (Aifa) has not yet approved reimbursement. Shortly in clinical practice, we will see other drugs such as trastuzumab deruxtecan, in HER2 positive tumors, which is very promising, or new strategies such as l’immunoterapia which will play an important role in the immediate therapeutic future of this neoplasm. This derives from the increase in biological knowledge which, together with the availability of new drugs, will allow important improvements in the possibilities of treatment. If it is true that we must try to diagnose stomach cancer earlier and earlier it is increasingly true that the chances of recovery and long survival are goals that are achievable by most patients. I hope I have reassured you. Last recommendation, rely on experts in this tumor, oncologists or surgeons, because this is also an index of the chances of success.
July 22, 2021 (change July 22, 2021 | 13:01)