Introduction: A Comprehensive Approach to Gastric Cancer Treatment
Gastric cancer remains a major oncological challenge requiring a comprehensive and individualized approach to treatment. Modern oncology aims not only to destroy the tumor but also to improve patients' quality of life, minimize side effects, and prevent disease progression in the early stages. Treatment may include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. The choice of a specific regimen depends on the disease stage, the patient's general condition, and the histological type of the tumor.
Chemotherapy in Gastric Cancer Treatment: Challenges and Prospects
Chemotherapy is one of the main systemic treatment modalities for gastric cancer, used both as neoadjuvant (preoperative) and adjuvant (postoperative) therapy, as well as in metastatic disease. However, despite its significance, the efficacy of chemotherapy can be limited. In some cases, particularly in advanced and refractory forms of gastric cancer, standard regimens of chemotherapy, immunotherapy, and targeted therapy may not yield the desired result [8].
An example of such complex cases is hepatoid adenocarcinoma of the stomach (HAS), a rare histological subtype with an unfavorable prognosis. In one described clinical case, an elderly patient with metastatic gastric cancer that progressed after first-line treatment—including chemotherapy, immunotherapy, and targeted therapy—achieved a complete pathological response to combined PRaG therapy. This therapy included radiation therapy, PD-1 blockade, and granulocyte-macrophage colony-stimulating factor (GM-CSF) [8]. This case highlights that when standard approaches, including chemotherapy, prove ineffective, innovative and multimodal strategies can be considered.
Thus, while chemotherapy remains a cornerstone in gastric cancer treatment, the continuous search for new combinations and alternative treatments is a priority for improving outcomes, especially for patients with refractory forms of the disease.
Supportive Care: Reducing Treatment Side Effects
Cytotoxic therapy, including chemotherapy, is often accompanied by a number of undesirable side effects that can significantly impair patients' quality of life and even lead to treatment interruption. The problem of gastrointestinal complications, such as alimentary tract mucositis and chemotherapy-induced nausea and vomiting (CINV), is particularly relevant [6]. These conditions are frequent and debilitating, especially in children and adolescents receiving anticancer treatment [6].
Clinical guidelines are being developed and updated to prevent and manage these side effects. For example, the combined use of 5-HT3 receptor antagonists and dexamethasone is effective in preventing acute and delayed nausea and vomiting [6]. Ongoing research aims to find new ways to prevent mucositis and CINV, which is an important part of supportive care in oncology [6]. Managing these symptoms helps patients better tolerate treatment and improves overall therapy outcomes.
Prevention and Management of Gastric Precancerous Conditions
An important aspect of combating gastric cancer is the prevention and timely treatment of precancerous conditions. Chronic atrophic gastritis (CAG) is a common precancerous condition that can progress to gastric cancer [7]. CAG is often associated with Helicobacter pylori (HP) infection [3].
Traditional Chinese medicine (TCM) is being actively researched as a complementary or alternative therapy for treating CAG and other gastrointestinal diseases:
- Xiaoliu Jin Jianwei decoction combined with acupuncture has shown improvements in gastrointestinal symptoms and gastric mucosal condition in patients with CAG. The combination therapy significantly reduced GSRS (Gastrointestinal Symptom Rating Scale) scores, histopathological scores, and levels of inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-α), demonstrating an overall efficacy of 93.40% versus 71.60% for decoction monotherapy [1].
- He-Wei decoction (HWD) is also used to treat CAG. It acts by modulating the TLR4/NF-κB signaling pathway, which helps strengthen the spleen, replenish qi, resolve stasis, and provide detoxification [2].
- Qingyoufang decoction (QYFD) has shown efficacy as an adjunctive therapy for HP-positive CAG, especially in patients with spleen-stomach damp-heat syndrome. In a retrospective study, the addition of QYFD to standard bismuth-based quadruple therapy improved HP eradication rates and syndrome symptoms [3].
- Weifuchun (WFC) formula alleviates MNNG-induced CAG by improving gastric and intestinal microbiota homeostasis. Studies have shown that WFC reduces pathological changes and inflammatory markers while modulating key proteins of the IL-6/JAK1/STAT3 signaling pathway [7].
In addition to precancerous conditions, TCM is also used for other GI disorders. For example, the Anwei Qingyou formula combined with standard triple therapy significantly increased the overall clinical efficacy in treating gastric ulcers (up to 97.57% vs. 82.50% for monotherapy) and reduced relapse rates [4]. Modern drugs, such as dual delayed-release esomeprazole (HIP2101), are also used to treat gastric erosions, showing comparable efficacy to famotidine in improving erosions [5].
Innovative Approaches and the Future of Gastric Oncology
The future of gastric cancer treatment lies in the development of personalized medicine and the implementation of innovative therapeutic strategies. As the case with PRaG therapy demonstrated, the combination of various modalities—such as radiation therapy, immunotherapy (PD-1 blockade), and cytokine therapy (GM-CSF)—can lead to impressive results even when standard approaches prove ineffective [8]. These methods aim to enhance the antitumor immune response and increase tumor sensitivity to treatment.
Ongoing research in tumor molecular biology and immunology opens new possibilities for developing targeted drugs and immunotherapeutic agents that can be integrated into existing treatment regimens or offered as alternatives. A comprehensive approach that considers not only the tumor type but also the patient's individual characteristics, along with the potential use of auxiliary methods like TCM to manage co-existing conditions, is key to improving the prognosis and quality of life for gastric cancer patients.
Sources
- 1. Rapid acupuncture combined with Xiaoliu Jin Jianwei decoction improves gastrointestinal symptoms and gastric mucosal lesions in chronic atrophic gastritis. https://pubmed.ncbi.nlm.nih.gov/42007096/
- 2. He-Wei decoction ameliorates chronic atrophic gastritis via modulation of the TLR4/NF-κB signaling pathway. https://pubmed.ncbi.nlm.nih.gov/41083380/
- 3. Efficacy and safety of adjunctive Chinese herbal decoction in treating Helicobacter pylori-positive chronic atrophic gastritis: A real-world retrospective study. https://pubmed.ncbi.nlm.nih.gov/41601815/
- 4. Clinical effect of Anwei Qingyou prescription on peptic ulcer and its influence on EGF and PGE2 levels: A retrospective study. https://pubmed.ncbi.nlm.nih.gov/36221352/
- 5. Evaluation of efficacy and safety of esomeprazole 10 mg dual delayed-release formulation in patients with gastric erosions: A multicenter, randomized, double-blind, active-controlled phase III study. https://pubmed.ncbi.nlm.nih.gov/39949051/
- 6. Prevention of gastrointestinal side effects in pediatric oncology: What are the recommendations? https://pubmed.ncbi.nlm.nih.gov/28333866/
- 7. Weifuchun alleviates MNNG-induced chronic atrophic gastritis by improving gastric and intestinal microbiota homeostasis. https://pubmed.ncbi.nlm.nih.gov/41284643/
- 8. Case report: Complete pathological response to PRaG therapy in an elderly patient with refractory metastatic gastric cancer. https://pubmed.ncbi.nlm.nih.gov/41626177/
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