Friday, December 27, 2013

Current treatment of Gastric cancer (New patient at GECC)

Local disease

Surgery cure rates in node negative diseases 75 to 20%
for stage III (node positive)  5 year survival  20-25%  (the reverse)

In the US, post-operative 5-FU-Leucovorin --RT--5-FU/LV (sandwish) has been standard of care

Neoadjuvant Chemotherapy  (rarely +RT) is used particularly when lesion is obstructive...but certainly not standard.   Most of the time Neoadjuvant chemotherapy is given to shrink the lesion to allow better surgery. Decision to offer this option is made after consultation with the surgeon.

With the results of the DUTCH study, D2 surgery has won the argument and should be offered to our patients!You don't have to be Asian to call for it as a patient

In Metastatic disease

1.DCF is still the main option in good performance patient
but brace yourself for the 30% Febrile Neutropenia rate and use growth factors
otherwise use EOX  (we still use in hospital ECF for poor folks that can't afford Xeloda or can't afford PO medications) I am facing this situation now with an uninsured patient.

2.Her-2 positive patients, will get Trastuzumab and chemotherapy-standard of care now(ToGA trial)

Lapatinib, Panitumumab and Cetuximab (and Irinotican) have a role, particularly in 2nd line therapy,

AT CRBCM, further targets are being actively investigated.
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