Navigating Treatment Options for Advanced Gastric Cancer
- Navigating the treatment options for advanced gastric cancer can feel overwhelming and confusing — and the approach is often different than what would be taken with more localized disease.
- Dr. Nicholas J Hornstein, a medical oncologist at Northwell Cancer Institute, tells SurvivorNet advanced gastric cancer is like a marathon, while treatment in earlier stages is like a sprint.
- The three major treatment approaches at advanced stages of disease typically include chemotherapy, immunotherapy, and targeted therapy.
- Eligibility for these systemic treatments depends on several factors: stage of the cancer, previous treatments, biomarkers testing, general health.
While doctors determine eligibility for treatments based on many factors, being eligible or ineligible doesn’t define the journey ahead entirely. Here, we’ll explore systemic treatments for advanced gastric cancer and share guidance on coping with this diagnosis.
Systemic Treatments Options
Read MoreChemotherapy
This treatment uses drugs to target and destroy rapidly dividing cells, including cancer cells. For gastric cancer, chemotherapy can shrink tumors, relieve symptoms, and, in some cases, extend life. Though chemotherapy can cause side effects like nausea and fatigue, doctors will work with you to manage these as best as possible.“This is really what we think of when we think of anti-cancer therapies. These can cause nausea, hair loss, or neuropathy, which is painful. Tingling in the hands and feet, and this is really what has commonly been used over the last 50 years to treat cancer,” Dr. Hornstein explains.
Am I Eligible For Targeted Therapies Like Herceptin, Enhertu, or Vyloy?
Targeted therapies are designed to attack specific features of cancer cells. For instance, HER2-positive gastric cancer can be treated with a targeted therapy like Enhertu or Herceptin, which directly attacks HER2-positive cells. While not everyone is eligible for targeted therapies, for those who are, it can be an important part of their treatment plan. Another option, particularly for patients whose cancer expresses certain proteins, such as claudin 18.2. Vyloy is a promising option for specific cases of advanced gastric cancer where patients test positive for caudin 18.2 and negative for human epidermal growth factor receptor 2 (HER2).
Am I Eligible To Receive Immunotherapy?
Pembrolizumab (brand name Keytruda) or Nivolumab (brand name Opdivo) are examples of checkpoint inhibitors, a specific type of immunotherapy, that targets PDL1 and can be used for some patients with advanced gastric cancer.
By blocking this pathway, immunotherapy can stimulate the body’s immune system to recognize and attack cancer cells more effectively. Although this treatment is only suitable for certain patients, it represents a beacon of hope for some with advanced gastric cancer.
What are checkpoint inhibitors?
Simply put, checkpoint inhibitors are a class of immunotherapy drugs that specifically target proteins found either on immune or cancer cells to prevent their binding together.
The advent of checkpoint inhibitors in treating cancer is that it doesn’t kill cancer cells directly, but it stimulates the immune system to find the cancer cells and attack them while hopefully not affecting other surrounding healthy cells.
Eligibility: Just One Piece of the Puzzle
Eligibility for systemic treatments like chemotherapy, targeted therapy, and immunotherapy depends on various factors, including:
- Stage of cancer
- Previous treatments
- Biomarkers testing
- General health
While eligibility decisions are important, it’s crucial to remember they are not the full story. Doctors weigh numerous factors, and they are committed to crafting a treatment plan that aligns with both medical standards and your needs.
Questions to Ask Your Doctor
- What stage is my gastric cancer? Has it spread to other organs?
- Can we surgically remove it?
- Does my tumor harbor genetic mutations such as Claudin 18.2 or HER2?
- Am I eligible to receive immunotherapy such as Herceptin? Or Vyloy? Or Enhertu?
- What are the potential side effects of these treatments and how can I manage them?
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