Targeted therapies for advanced and metastatic adenocarcinoma of the gastroesophageal junction: is there something new?

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• 作者：Felice Pasini ; Anna Paola Fraccon ; Yasmina Modena ; Maria Bencivenga…
• 关键词：Gastroesophageal junction adenocarcinoma ; Advanced disease ; Targeted therapies
• 刊名：Gastric Cancer
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：20
• 期：1
• 页码：31-42
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Surgical Oncology; Oncology; Abdominal Surgery; Gastroenterology; Cancer Research;
• 出版者：Springer Japan
• ISSN：1436-3305
• 卷排序：20

文摘

Despite improvements in systemic chemotherapy (CT), the prognosis of metastatic adenocarcinoma of the gastroesophageal junction remains poor. Over the years, new targeting agents have become available and were tested, with or without CT, in first or subsequent lines of therapy. The epidermal growth factor receptor family was targeted with monoclonal antibodies (MoAbs) (trastuzumab, cetuximab, panitumumab) and tyrosin kinase inhibitors (TKIs) (lapatinib, erlotinib, gefitinib). Only trastuzumab, in combination with cisplatin and fluoropyrimidines, significantly improved overall survival (OS) in first-line therapy (13.8 vs. 11.1 months). Angiogenesis also was targeted with MoAbs (bevacizumab and ramucirumab); ramucirumab, a vascular endothelial growth factor-receptor 2 antagonist, enhanced OS in two phase III studies in the first (9.6 vs. 7.4 months) and subsequent lines of treatment (5.2 vs. 3.8 months), while the bevacizumab study was negative. TKIs (sunitinib, sorafenib, regorafenib, apatinib) were tested in this setting in phase II studies in the second/third line, only showing modest antitumor activity. The hepatocyte growth factor receptor (MET) was targeted in untreated patients in a phase III trial with MoAb rilotumumab, with or without CT, but the study was stopped because of mortality excess in the rilotumumab arm. Mammalian target of rapamycin (MTOR) pathway inhibition with everolimus was tested in pretreated patients in a placebo-controlled phase III trial who failed to improve OS (5.4 vs. 4.3 months). In conclusion, considering the modest survival gain obtained overall, the high cost of these therapies and the quality of life issue must be primarily considered in treating these patients.