• Journal of Gastric Cancer
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• v.23 no.1
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• pp.224-249
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• 2023

Gastric cancer is heterogeneous in morphology, biology, genomics, and treatment response. Alterations in human epidermal growth factor receptor 2 (HER2) overexpression, microsatellite instability (MSI) status, programmed death-ligand 1 (PD-L1) levels, and fibroblast growth factor receptor 2 (FGFR2) can be used as biomarkers. Since the combination of fluoropyrimidine/platinum plus trastuzumab that was investigated in the ToGA trial was approved as a standard of care in HER2-positive patients in 2010, no other agents showed efficacy in the first- (HELOISE, LOGiC, JACOB trials) and second- (TyTAN, GATSBY, T-ACT trials) line treatments. Despite the success in treating breast cancer, various anti-HER2 agents, including a monoclonal antibody (pertuzumab), an antibody-drug conjugate (ADC; trastuzumab emtansine [T-DM1]), and a small molecule (lapatinib) failed to translate into clinical benefits until the KEYNOTE-811 (first-line) and DESTINY-Gastri01 (≥second-line) trials were conducted. The incorporation of HER2-directed treatment with immune checkpoint inhibitors in the form of a monoclonal antibody or ADC is now approved as a standard treatment. Despite the promising results of new agents (engineered monoclonal antibodies, bi-specific antibodies, fusion proteins, and small molecules) in the early phase of development, the management of HER2-positive gastric cancer requires further optimization to achieve precision medicine with a chemotherapeutic backbone. Treatment resistance is a complex process that can be overcome using a combination of chemotherapy, targeted agents, and immune checkpoint inhibitors, including novel agents. HER2 status must be reassessed in patients undergoing anti-HER2 treatment with disease progression after the first-line treatment. As a general guideline, patients who need systemic treatment should receive chemotherapy plus targeted agents, anti-angiogenic agents, immune checkpoint inhibitors, or their combinations.

• Journal of Digestive Cancer Research
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• v.4 no.2
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• pp.99-106
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• 2016

Minimally invasive surgery for gastric cancer has increased in popularity during the last two decades mainly in the Asia for patients with early-stage cancer. Nevertheless, the development of laparoscopic surgery for gastric cancers in the Western world has been slow because of the advanced stage at diagnosis for which LG is not yet considered an acceptable alternative to standard open surgery. RAG has been reported as a safe alternative to conventional surgery for treating of early gastric carcinoma. We assess the current status of robotic surgery in the treatment of gastric cancer focusing on the technical details, postoperative outcome, oncological considerations and future perspectives. In gastrectomy the biggest advantage of the robotic approach is the ease and reproducibility of lymphadenectomy. Reports also show that even the intra corporeal digestive restoration is facilitated by use of the robotic approach, particularly following TG. Additionally, the accuracy of robotic dissection is confirmed by decreased blood loss in comparison to conventional laparoscopy. The learning curve and technical reproducibility also appear to be shorter with robotic surgery and, consequently, robotics can help to standardize and diffuse minimally invasive surgery in the treatment of gastric cancer. While published reports have shown no significant differences in surgical morbidity, mortality, or oncological adequacy between robot-assisted and conventional gastrectomy. There are some advantages in terms of postoperative recovery of patients after robotic surgery. More studies are needed to assess the true indications and oncological effectiveness of robotic use in the treatment of gastric carcinoma.

• Journal of Gastric Cancer
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• v.17 no.1
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• pp.88-92
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• 2017

Early detection and treatment decrease the mortality rate associated with gastric cancer (GC). However, the natural history of GC remains unclear. An 85-year-old woman was referred to our hospital for evaluation of a gastric tumor. Esophagogastroduodenoscopy identified a 6 mm, flat-elevated lesion at the lesser curvature of the antrum. A biopsy specimen showed a well-differentiated tubular adenocarcinoma. The depth of the lesion was estimated to be intramucosal. Although the lesion met the indications for endoscopic resection, periodic endoscopic follow-up was performed due to the patient's advanced age and comorbidities. The mucosal GC invaded into the submucosa 3 years later, and finally progressed to advanced cancer 5 years after the initial examination. The patient died of tumor hemorrhage 6.4 years after the initial examination. In this case, mucosal GC progressed to advanced GC, eventually leading to the patient's death from GC. Early and appropriate treatment is required to prevent GC-related death.

• Journal of Gastric Cancer
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• v.24 no.1
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• pp.122-134
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• 2024

Most gastric subepithelial tumors (SETs) are asymptomatic and are often incidentally discovered during endoscopic procedures conducted for unrelated reasons. Although surveillance is sufficient for the majority of gastric SETs, certain cases necessitate proactive management. Laparoscopic wedge resection, although a viable treatment option, has its limitations, particularly in cases where SETs (especially those with intraluminal growth) are not visualized on the peritoneal side. Recent advances in endoscopic instruments and technology have paved the way for the feasibility of endoscopic resection of SETs. Several promising endoscopic techniques have emerged for gastric SET resection, including submucosal tunneling endoscopic resection, endoscopic full-thickness resection (EFTR), laparoscopic and endoscopic cooperative surgery (LECS), and non-exposure EFTR (non-exposed endoscopic wall-inversion surgery and non-exposure simple suturing EFTR). This study aimed to discuss the indications, methods, and outcomes of endoscopic therapy for gastric SETs. In addition, a simplified diagram of the category of SETs according to the therapeutic indications and an algorithm for the endoscopic management of SET is suggested.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3437-3442
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• 2013

The high incidence of gastric cancer and consequent mortality pose severe threats to human health. Early screening, diagnosis and treatment are the key to improve the prognosis of the patients with gastric cancer. Gastroscopy with biopsy is an efficient method for the diagnosis of early gastric cancer, but the associated discomfort and high cost make it difficult to be a routine method for screening gastric cancer. Serum tumor marker assay is a simple and practical method for detection of gastric cancer, but it is limited by poor sensitivity and specificity. Therefore, people have been looking for novel serum markers of gastric cancer in recent years. Here we review the novel serum tumor markers of gastric cancer and their diagnostic significance, focusing on the discoveries from serum proteomics analyses and epigenetics researches.

• BMB Reports
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• v.47 no.12
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• pp.697-702
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• 2014

Recently, the interest in natural products for the treatment of cancer is increasing because they are the pre-screened candidates. In the present study, we demonstrate the therapeutic effect of celastrol, a triterpene extracted from the root bark of Chinese medicine on gastric cancer. The proliferation of AGS and YCC-2 cells were most sensitively decreased in six kinds of gastric cancer cell lines after the treatment with celastrol. Celastrol inhibited the cell migration and increased G1 arrest in cell-cycle populations in both cell lines. The treatment with celastrol significantly induced autophagy and apoptosis and increased the expression of autophagy and apoptosis-related proteins. We also found an increase in phosphorylated AMPK following a decrease in all phosphorylated forms of AKT, mTOR and S6K after the treatment with celastrol. Moreover, gastric tumor burdens were reduced in a dose-dependent manner by celastrol administration in a xenografted mice model. Taken together, celastrol distinctly inhibits the gastric cancer cell proliferation and induces autophagy and apoptosis.

• Journal of Gastric Cancer
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• v.4 no.3
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• pp.176-179
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• 2004

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.

• Journal of Gastric Cancer
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• v.16 no.2
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• pp.111-114
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• 2016

Herein, we report a 39-year-old female patient presenting with gastric cancer and tuberculous peritonitis. The differential diagnosis between advanced gastric cancer with peritoneal carcinomatosis and early gastric cancer with peritoneal tuberculosis (TB), and the treatment of these two diseases, were challenging in this case. Physicians should have a high index of suspicion for peritoneal TB if the patient has a history of this disease, especially in areas with a high incidence of TB, such as South Korea. An early diagnosis is critical for patient management and prognosis. A surgical approach including tissue biopsy or laparoscopic exploration is recommended to confirm the diagnosis.

• Journal of Gastric Cancer
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• v.13 no.3
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• pp.129-135
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• 2013

Gastric cancer is the second leading cause of cancer-related deaths worldwide. In advanced and metastatic gastric cancer, the conventional chemotherapy with limited efficacy shows an overall survival period of about 10 months. Patient specific and effective treatments known as personalized cancer therapy is of significant importance. Advances in high-throughput technologies such as microarray and next generation sequencing for genes, protein expression profiles and oncogenic signaling pathways have reinforced the discovery of treatment targets and personalized treatments. However, there are numerous challenges from cancer target discoveries to practical clinical benefits. Although there is a flood of biomarkers and target agents, only a minority of patients are tested and treated accordingly. Numerous molecular target agents have been under investigation for gastric cancer. Currently, targets for gastric cancer include the epidermal growth factor receptor family, mesenchymal-epithelial transition factor axis, and the phosphatidylinositol 3-kinase-AKT-mammalian target of rapamycin pathways. Deeper insights of molecular characteristics for gastric cancer has enabled the molecular classification of gastric cancer, the diagnosis of gastric cancer, the prediction of prognosis, the recognition of gastric cancer driver genes, and the discovery of potential therapeutic targets. Not only have we deeper insights for the molecular diversity of gastric cancer, but we have also prospected both affirmative potentials and hurdles to molecular diagnostics. New paradigm of transdisciplinary team science, which is composed of innovative explorations and clinical investigations of oncologists, geneticists, pathologists, biologists, and bio-informaticians, is mandatory to recognize personalized target therapy.

• Journal of Gastric Cancer
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• v.4 no.2
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• pp.95-108
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• 2004

This nationwide survey was conducted to evaluate the current status of clinical practice for gastric cancer patients in Korea. The Information Committee of the Korean Gastric Cancer Association (KGCA) sent questionnaires containing 45 items about the preoperative diagnosis, medical and surgical treatment, and postoperative follow-up for gastric cancer patients to all 298 KGCA members in 108 institutes. Response rates were $32.6\%$ (97/298) for individuals and $59.3\%$ (64/108) for institutes. Most university hospitals responded (response rate of university hospitals: $71.6\%$, 48/67). The preoperative staging work up was performed primarily by abdominal CT, followed by bone scans, abdominal ultrasound, endoscopic ultrasound, and so on. Gastric cancer patients with stages II, III, and IV usually received adjuvant chemotherapy after a curative operation. About half of the surgeons regarded 2 cm as a safe resection margin in early gastric cancer and 5 cm in advanced gastric cancer. More than half of surgeons usually performed a D2 lymph node dissection in early gastric cancer and D2+$\alpha$ lymph node dissection in advanced gastric cancer. About $20\%$ of surgeons performed less invasive surgery and/or function-preserving surgery, such as a pylorus-preserving gastrectomy, a laparoscopic wedge resection, or a laparoscopy-assisted distal gastrectomy.