IntroductionStomach (gastric) cancer is a significant health concern worldwide, ranking as the fifth most common cancer and the third leading cause of cancer-related deaths. Targeted therapy has emerged as a pivotal treatment modality in the management of gastric cancer, offering a more precise and effective approach compared to traditional chemotherapy. This therapy involves the use of drugs designed to target specific molecules involved in the growth, progression, and spread of cancer cells, thus minimizing damage to normal cells.
How is Targeted Therapy Used for Gastric Cancer?Targeted therapy for gastric cancer primarily focuses on two main targets:
HER2 (human epidermal growth factor receptor 2)
VEGF (vascular endothelial growth factor)
HER2-Targeted TherapyHER2 is a protein that promotes the growth of cancer cells. In about 15-20% of gastric cancers, the cancer cells have an excess of HER2 due to gene amplification. Trastuzumab, a monoclonal antibody, targets the HER2 protein and has been shown to improve survival in patients with HER2-positive advanced gastric cancer when combined with chemotherapy (Bang et al., 2010).
VEGF-Targeted TherapyVEGF plays a crucial role in angiogenesis, the process by which new blood vessels form to supply nutrients to tumors. Ramucirumab, an antibody that targets the VEGF receptor 2, has been approved for the treatment of advanced gastric cancer. It works by inhibiting the VEGF pathway, thereby reducing blood supply to the tumor and hindering its growth (Fuchs et al., 2014).
Supportive CareSupportive care is essential for managing side effects and improving the quality of life for patients undergoing targeted therapy. Common side effects of HER2-targeted therapy include heart problems, which require regular monitoring of cardiac function. VEGF-targeted therapy can lead to hypertension, bleeding, and gastrointestinal perforations. Management strategies include:
Cardiac Monitoring: Regular echocardiogram or MUGA scans to assess heart function.
Blood Pressure Management: Use of antihypertensive medications and lifestyle modifications.
Nutritional Support: Dietary interventions to manage nausea, diarrhea, and other gastrointestinal symptoms.
Psychological Support: Counseling and support groups to help patients cope with the emotional and psychological impact of cancer treatment.
Personalization of TreatmentPersonalized medicine is becoming increasingly important in the treatment of gastric cancer. The identification of specific biomarkers, such as HER2 and VEGF, allows for the selection of targeted therapies tailored to the molecular profile of the patient's tumor. Advances in genomic profiling and next-generation sequencing are facilitating the discovery of new targets and the development of novel targeted therapies. This approach ensures that patients receive the most effective treatment with the least amount of toxicity.
Future DirectionsThe future of targeted therapy for gastric cancer looks promising, with ongoing research aimed at identifying new targets and developing innovative drugs. Some of the key areas of focus include:
Immunotherapy: Combining targeted therapy with immune checkpoint inhibitors to enhance the immune system's ability to recognize and attack cancer cells.
Combination Therapies: Exploring the synergistic effects of combining multiple targeted therapies or integrating them with traditional chemotherapy and radiation therapy.
Biomarker Discovery: Identifying new biomarkers that can predict response to targeted therapy and guide treatment decisions.
Precision Medicine: Advancing the use of precision medicine approaches to tailor treatment plans based on the unique genetic and molecular characteristics of each patient's cancer.
ReferencesBang, Y. J., Van Cutsem, E., Feyereislova, A., Chung, H. C., Shen, L., Sawaki, A., ... & Ohtsu, A. (2010). Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial.
Fuchs, C. S., Tomasek, J., Yong, C. J., Dumitru, F., Passalacqua, R., Goswami, C., ... & Van Cutsem, E. (2014). Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial.
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