Fast Five Quiz: Gastric Cancer Management

Elwyn C. Cabebe, MD


April 06, 2022

For medically fit patients with potentially resectable cT1b gastric cancer, the NCCN recommends surgery. For those with cT2 disease or higher (any N), recommendations are surgery only, perioperative chemotherapy with surgery (category 1) (preferred) or preoperative chemoradiation with surgery (category 2B).

Systemic therapy options include:

  • Perioperative chemotherapy: Preferred regimens are FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel [Taxotere]) (category 1) and a fluoropyrimidine plus oxaliplatin.

  • Preoperative chemoradiation: Infusional fluorouracil can be replaced with capecitabine.

  • Postoperative chemoradiation in patients who received less than a D2 lymph node dissection: Infusional fluorouracil or capecitabine before and after fluoropyrimidine-based chemoradiation.

  • Postoperative chemoradiation in patients who have undergone primary D2 lymph node dissection: Preferred regimens are capecitabine and oxaliplatin (category 1) and fluorouracil and oxaliplatin.

The NCCN guidelines for treatment of early-stage (Tis, or T1a) gastric cancer indicate endoscopic mucosal resection or surgery as the standard treatment option, with complete surgical resection offering the potential for long-term survival. Posttreatment endoscopic surveillance is indicated.

For surgically unresectable locoregional disease, the NCCN recommends chemoradiation, systemic therapy, or palliative management. Preferred regimens are fluorouracil (or capecitabine) and either oxaliplatin or cisplatin.

For metastatic gastric cancer, the NCCN recommends palliative chemotherapy based around a doublet or triplet platinum/fluoropyrimidine combination. Local therapy is not indicated. HER2 and PD-L1 testing are recommended upon confirmation of metastatic disease. Entry into a clinical trial should also be considered.

Learn more about the treatment of gastric cancer.


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