Beschreibung:
Background: Adenocarcinoma of the stomach and esophagogastricjunction (EGJ) remains a tumor entity with a poorprognosis. While meaningful advances have been made inthe treatment of other solid tumors in the past years, numerousphase III studies in gastric cancer have had negative outcomes.Successes of targeted therapies so far include theintroductionof trastuzumab in the first-line treatment ofHER2-positive gastric cancer, and second-line anti-angiogenictreatment with the anti-VEGF-2 receptor antibodyramucirumab. Taxanes have become established in the perioperativesetting and in second-line treatment and have setnew standards. However, evidence for improved overall survivalin the first-line treatment of advanced gastric cancerwith taxanes is not convincing. Methodology: Expert consensusdiscussion on the scientific and clinical evidence forsequential systemic treatment for advanced gastric and EGJcancer, taking into account data clinical outcomes from randomizedcontrolled phase II and phase III trials. Summary: Infirst-line treatment of advanced gastric cancer, taxanes incombination with a platinum- and 5-fluorouracil-based regimenare generally not recommended because they lack asurvival benefit and confer high toxicity. However, taxanesin first-line can be a treatment option for patients presentingwith high tumor burden and strong pressure to achieve remission.Since the publication of several positive studies insecond- and third-line therapy, sequential therapy is playingan increasingly important role in metastatic gastric and EGJcancer. Key Message: Standard of care for the first-line treatmentof gastric cancer is a platinum-fluoropyrimidine chemotherapydoublet combination. The standard of care afterfailure of platinum-based first-line therapy is ramucirumabin combination with paclitaxel. Data supporting this combinationafter previous taxane therapy are not yet available.