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Stage 4 Gastric Cancer

 

Patients with stage 4 gastric cancer have cancer that has spread to distant sites. Optimal treatment for some patients with stage IV gastric cancer often requires more than one therapeutic approach. Thus, it is important for patients to be treated at a medical center that can offer multidisciplinary treatment involving medical oncologists, radiation oncologists, interventional radiologists, surgeons, gastroenterologists, nutritionists, and access to clinical trials.

 

Surgery

 

For patients with Stage 4 gastric cancer, surgery may be performed to reduce bleeding or to keep the cancer from obstructing the intestines or stomach.

 

Chemotherapy

 

Chemotherapy can relieve symptoms and extend survival for some patients with advanced gastric cancer. Several chemotherapy regimens are available, and the choice of which to use depends in part on the patient’s health. Chemotherapy may be used in combination with other treatments such as targeted treatments, precision cancer medicine, radiation therapy, and/or surgery.

 

Precision Cancer Medicines

 

All patients with advanced gastric cancer should undergo genomic biomarker testing for HER2, PD-1 and other targets to determine if they can benefit from treatment with a precision cancer medicine.

 

Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be used to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack gastric cancer cells with specific abnormalities, leaving normal cells largely unharmed.

 

Roughly 20% of patients with gastric cancer have cancer that over expresses (makes too much of) this protein; these cancers are referred to as HER2-positive. For patients with HER2-positive, metastatic gastric cancer, treatment with Herceptin can improve overall survival.

 

Radiation Therapy

 

Radiation therapy involves the use of a particular type of energy, known as ionizing radiation, to kill cancer cells. Radiation can play a role in managing the symptoms of advanced gastric cancer and can also help to control problems such as bleeding or blockages.

 

All patients with advanced gastric cancer should undergo genomic biomarker testing for HER2 and other targets to determine if they can benefit from treatment with a precision cancer medicine.

 

Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be used to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack gastric cancer cells with specific abnormalities, leaving normal cells largely unharmed.

 

Herceptin® (trastuzumab) is a targeted therapy that interferes with specific pathways involved in the growth or spread of cancer. A protein known as HER2 (human epidermal growth factor receptor contributes to cancer growth and cancers that test positive for HER2 may be treated with a HER2-targeting drug called Herceptin® (trastuzumab). Herceptin can be used alone or in combination with chemotherapy, and can prolong patient survival with advanced, HER2-positive gastric cancer.

 

Immunotherapy

 

Checkpoint Inhibitors are monoclonal antibodies that helps to restore the body’s immune system in fighting cancer. They create their anti-cancer effects by blocking a specific protein used by cancer cells called the programmed death-1 (PD-1), to escape an attack by the body’s immune system. When PD-1 is blocked or inhibited, cells of the immune system identify cancer cells as a threat and initiate an attack to destroy the cancer.

 

• Keytruda – The KEYNOTE 059 clinical trial compared Keytruda, Keytruda + chemotherapy and chemotherapy alone in patients with advanced gastric cancer. Keytruda as a single drug was as good as chemotherapy but the combination was no better.

• Opdivo (nivulomab) was found to produce superior survival duration compared to placebo in patients with advanced gastric cancer.

 

Clinical Trials:

 

New anti-cancer therapies continue to be developed and evaluated in clinical trials. There are three phases of clinical trials before approval.  See our clinical trials section for more information.

 

Managing Liver Metastases

 

When gastric cancer spreads to the liver, it doesn’t always cause symptoms. It may be picked up by liver function tests, which are blood tests that measure certain levels of enzymes and proteins in the blood. Abnormal levels can indicate liver disease or damage.

 

If liver metastasis causes symptoms, they can include:

 

• pain or discomfort in the mid-section

• fatigue and weakness

• weight loss/poor appetite

• fever

• bloating

• swelling in the legs

• a yellow tint to the skin or the whites of the eyes

 

In addition to liver function tests, doctors use imaging tests to diagnose liver metastases. These may include MRI (magnetic resonance imaging), CT scan (computed tomography), ultrasound, and/or PET scan (positron emission tomography). Sometimes, a combined PET/CT scan is used.

 

Your doctor also may recommend getting a sample of the suspicious area(s) for examination under a microscope (biopsy). He or she may involve an interventional radiologist to obtain precise and minimally invasive imaging.

 

The most common treatments for metastatic gastric cancer in any location (bone, brain, lung, or liver) are systemic medications, which treat cancer throughout the entire body. Systemic medications include chemotherapy, targeted therapies, and clinical trials that have already been discussed.  Liver directed therapies, including surgery, may be an option.

 

Liver Directed Therapies: There are numerous liver directed therapies available for those who are faced with a Stage 4 cervical cancer diagnosis with liver metastases or gastric cancer that has spread to the liver.  These therapies are dependent on the size, number, and location of the liver tumors. These liver directed therapies may include chemoembolization, cryoablation, cyberknife, hepatic arterial infusion, liver resection, proton beam therapy, radioembolization or SIRT, radiofrequency ablation, or SBRT.  You can learn more on our treatment page under liver directed therapies.

 

 

 

 

 

 

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