Chemoterapie

• Increase survival
• Incirease time it takes the disease to progress
• Improved quality of life with chemotherapy [1]

Typy terepií

Adjuvant

Palliative

Neoadjuvant chemotherapy

Intraoperative radiotherapy (IORT)

Adjuvant chemotherapy (eg, 5-FU)

Adjuvant radiotherapy

Adjuvant chemoradiotherapy

Palliative radiotherapy

Palliative-intent procedures

• Wide local excision
• Partial gastrectomy
• Total gastrectomy
• Simple laparotomy
• Gastrointestinal anastomosis
• Bypass

• Fluorouracil
• Mitomycin
• Cisplatin
• doxorubicin
• Methotrexate [1]

• Standard regime
• Fluoropyrimidine + cisplatin [1]

• Platinum-based combination chemotherapy
• First-line regimens:
• Epirubicin + cisplatin + 5-FU / docetaxel + cisplatin + 5-FU
• Other regimens:
• Irinotecan + cisplatin
• Oxaliplatin + irinotecan
• Trastuzumab + cisplatin + capecitabine / 5-FU
• Who have not received previous treatment for metastatic disease
• Ramucirumab
• Advanced stomach cancer / gastroesophageal (GE) junction adenocarcinoma
• Unresectable
• Metastatic disease following therapy with a fluoropyrimidine- / platinum-containing regimen

Human epidermal growth factor receptor 2 (HER2) status

• HER2 positive tumours
• Can be treated with trastuzumab
• In addition to the standard fluoropyrimidine/cisplatin regimen [1]
• Trastuzumab
• Produces survival advantage in patients with metastatic gastric cancer, in whom HER-2 expression [57]

Cisplatina

• metformin and cisplatin separately reduced the viability of cancer cell [46]
• But in co-administration, metformin reduced the cytotoxicity of cisplatin [46]
• Survivin expression was increased followed by a reduction in cisplatin anti-cancer effect [46]
• Increased AKT expression [46]
• metformin is not an appropriate choice to make cells sensitive to cisplatin [46]

5-Fluorouracil (5-Fu)

• One of the most common used chemotherapeutic drugs on gastric cancer
• Can change into 5-Fu deoxynucleotide
• Can inhibit thymidylate synthase
• Block the methylation of deoxyguanylic acid (dGMP)
• Influence the synthesis of DNA
• Change into 5-Fu nucleoside
• Can mix into RNA as the form of false metabolite
• Influence the synthesis of proteins
• Although 5-Fu has cytopathic effect to cancer cells, it can also kill normal cells [79]