Stomach cancer, also known as gastric cancer, originates from the growth of abnormal cells within the stomach. Positioned in the upper middle section of the abdomen, just below the ribs, the stomach plays a crucial role in the digestion process by breaking down food particles. Stomach cancer can develop in any region of the stomach, although it predominantly occurs in the main portion known as the stomach body.
This type of cancer poses a significant health concern worldwide, affecting individuals regardless of age, gender, or geographical location. Early detection and treatment are essential for managing stomach cancer effectively and improving patient outcomes.
From chemotherapy to targeted therapies and immunotherapies, pharmaceutical interventions contribute significantly to the multifaceted battle against this formidable disease, underscoring their indispensable importance in the fight against stomach cancer.
It is important to note that these medications are always offered in combination and are rarely offered in and of themselves. To improve a patient’s outcomes, it becomes necessary to administer several drugs in combination. It is also to be noted that the decision to offer several medications also depends on several factors such as the stage of the cancer, the line of treatment chosen and the overall health of the patient.
Types of Stomach Cancer
Stomach cancer can manifest in various forms, depending on the type of cells where the cancer originates. Here are the main types:
Adenocarcinoma: This is the most common type of stomach cancer, starting in cells that produce mucus. Nearly all stomach cancers fall under this category.
Gastrointestinal stromal tumors (GIST): GISTs begin in special nerve cells within the stomach’s wall and other digestive organs. They are a type of soft tissue sarcoma.
Carcinoid tumors: These cancers arise from neuroendocrine cells, which perform nerve cell functions and hormone production. Carcinoid tumors belong to the broader category of neuroendocrine tumors.
Lymphoma: This type of cancer originates in immune system cells. If the body sends immune cells to the stomach to combat an infection, lymphoma might develop. Most stomach lymphomas are classified as non-Hodgkin’s lymphoma.
Understanding the different types of stomach cancer is crucial for diagnosis, treatment planning, and overall management of the disease.
Drugs Approved for Stomach (Gastric) Cancer
Here are the drugs approved for stomach cancer:
Fam-Trastuzumab Deruxtecan-nxki
Fam-Trastuzumab Deruxtecan-nxki, an antibody-drug conjugate, combines the monoclonal antibody trastuzumab with the cancer-killing drug deruxtecan. Trastuzumab targets the HER2 protein, abundant in certain cancer cells, while deruxtecan inhibits topoisomerase I enzyme, inducing DNA damage within the cells. This dual action kills cancer cells and prompts an immune response against surrounding cells. Approved by the FDA, it is utilized in adults with:
- Breast cancer that is unresectable or has metastasized, particularly in HER2-positive cases that have received prior anti-HER2 treatment or post-surgery chemotherapy.
- Gastric (stomach) cancer or gastroesophageal junction cancer (a rare form of esophageal cancer) that is HER2-positive and metastatic, after previous trastuzumab-containing therapy.
- Non-small cell lung cancer with specific HER2 gene mutations, unresectable or metastatic, in patients who have undergone systemic therapy.
5-FU
Fluorouracil, an antimetabolite chemotherapy drug, works by imitating a component of RNA and DNA, disrupting the cell’s ability to produce DNA and proteins. This interference slows down or halts the growth of cancer cells and other fast-dividing cells, ultimately leading to their demise.
Approved by the FDA, fluorouracil injection is utilized in the treatment of various cancers, including breast cancer, colorectal cancer, gastric (stomach) cancer, and pancreatic cancer. Commonly known as 5-FU, fluorouracil is under investigation for its potential effectiveness in treating other medical conditions and cancer types.
Fluorouracil Injection
Fluorouracil, an antimetabolite chemotherapy drug, disrupts cancer cell growth by mimicking a vital component of RNA and DNA. By hindering the cell’s ability to produce DNA and proteins, fluorouracil effectively slows down or halts the proliferation of cancer cells and other rapidly dividing cells, leading to their eventual demise.
Approved by the FDA, fluorouracil injection is utilized in the treatment of several cancers, including breast cancer, colorectal cancer, gastric (stomach) cancer, and pancreatic cancer. Commonly known as 5-FU, fluorouracil is also under investigation for its potential efficacy in treating various other medical conditions and cancer types.
Trastuzumab
Trastuzumab, a targeted therapy drug known as a monoclonal antibody, operates by binding to HER2, a protein prevalent on certain cancer cells. This binding action obstructs the chemical signals that prompt HER2-positive cancer cells to grow, while also activating the immune system to target and eliminate cells abundant in HER2.
Approved by the FDA, trastuzumab is employed either alone or in combination with other medications to combat HER2-positive breast cancer and metastatic stomach adenocarcinoma or gastroesophageal junction adenocarcinoma. In breast cancer cases, trastuzumab is administered as part of combination therapies or as a standalone treatment, depending on the stage and progression of the disease.
Trastuzumab’s versatility extends to various forms, including trastuzumab and hyaluronidase-oysk, pertuzumab, trastuzumab, and hyaluronidase-zzxf, and ado-trastuzumab emtansine, each serving distinct purposes in cancer treatment. Ongoing research continues to explore trastuzumab’s potential efficacy in combating other types of cancer.
Pembrolizumab
Pembrolizumab is an innovative type of immunotherapy known as an immune checkpoint inhibitor. It functions by engaging with a protein called PD-1 found on the surface of T cells, which are key players in the immune system. By binding to PD-1, pembrolizumab effectively prevents cancer cells from suppressing the immune response. This action empowers the immune system to recognize and attack cancer cells more effectively, ultimately leading to their destruction.
FDA-approved for a wide range of cancer types, pembrolizumab is used in various treatment scenarios. For instance, in breast cancer cases where the tumor is triple negative and expresses PD-L1, pembrolizumab is administered alongside chemotherapy to patients with advanced or metastatic cancer, or as a pre- and post-surgery treatment for early-stage cancer with a high risk of recurrence.
Similarly, in cervical cancer, pembrolizumab is employed either alone or in combination with chemotherapy or radiation therapy, depending on the stage and response to previous treatments. In advanced gastric cancer or gastroesophageal junction adenocarcinoma, pembrolizumab is utilized alongside platinum chemotherapy and fluoropyrimidine, especially in cases where the cancer is HER2 positive.
Moreover, pembrolizumab is beneficial in melanoma, non-small cell lung cancer, renal cell carcinoma, and urothelial carcinoma, among others. It is employed as a monotherapy or in combination with other medications, either as a first-line treatment or in cases where the cancer has relapsed or metastasized.
The versatility of pembrolizumab extends to other cancer types, including Hodgkin lymphoma, cutaneous squamous cell carcinoma, and squamous cell carcinoma of the head and neck. In each instance, pembrolizumab offers a promising avenue for treatment, particularly in cases where traditional therapies have proven ineffective or where the cancer has become resistant to treatment.
Ongoing research continues to explore pembrolizumab’s potential across various cancer types, offering hope for improved outcomes and expanded treatment options for patients facing these challenging diseases.
Trifluridine and Tipiracil Hydrochloride
Trifluridine and tipiracil hydrochloride is a chemotherapy combination designed to combat certain types of cancer, particularly colorectal cancer and stomach adenocarcinoma that has spread to other parts of the body. This combination comprises trifluridine, which interferes with DNA replication by incorporating itself into the DNA, hindering cell division. Additionally, tipiracil hydrochloride plays a crucial role by preventing the breakdown of trifluridine in the body, allowing it to effectively kill cancer cells.
Approved by the FDA, this treatment is prescribed for adults who have already undergone previous chemotherapy regimens and may be used alone or in combination with other medications, such as bevacizumab. Trifluridine and tipiracil hydrochloride offer hope for patients facing advanced stages of colorectal cancer or certain types of esophageal cancer, providing a potential pathway to slowing disease progression and improving overall outcomes.
Taxotere
Docetaxel, a chemotherapy drug belonging to the taxane class, operates by disrupting microtubules within cells, crucial for chromosome movement during cell division. By impeding this process, docetaxel halts the proliferation of cancer cells and other rapidly dividing cells.
Approved by the FDA, docetaxel is prescribed either as a standalone treatment or in combination with other medications for various cancer types:
- In breast cancer cases where previous chemotherapy has been ineffective, docetaxel offers a therapeutic option. Additionally, it forms part of a regimen with doxorubicin hydrochloride and cyclophosphamide for node-positive breast cancer amenable to surgical removal.
- Non-small cell lung cancer patients may receive docetaxel as a monotherapy if platinum chemotherapy failed. Alternatively, it can be combined with cisplatin for untreated cases ineligible for surgery.
- For castrate-resistant prostate cancer, docetaxel is utilized in individuals with metastatic disease.
- Locally advanced squamous cell carcinoma of the head and neck is treated with docetaxel in conjunction with cisplatin and fluorouracil.
- Docetaxel is also employed in advanced stomach adenocarcinoma or gastroesophageal junction adenocarcinoma cases where prior chemotherapy was not administered.
These applications, endorsed by the FDA, underline docetaxel’s significance in combating various forms of cancer, offering hope to patients facing these challenging conditions.
Capecitabine
Capecitabine, an antimetabolite chemotherapy drug, undergoes metabolic breakdown in the body, yielding substances that disrupt DNA, RNA, and protein production. Consequently, the growth of cancer cells and other fast-dividing cells is impeded, leading to their eventual demise. Approved by the FDA, capecitabine is prescribed alone or in combination with other medications to address various cancer types. For instance, in breast cancer cases that have metastasized, capecitabine serves as a standalone treatment option for individuals unfit for anthracycline or taxane chemotherapy drugs.
It also complements docetaxel treatment in patients who previously received anthracycline chemotherapy but showed progression. Similarly, in colorectal cancer, capecitabine is utilized in multiple scenarios, including adjuvant therapy after surgery for stage III colon cancer and in combination with radiation therapy for locally advanced rectal cancer.
Additionally, it is employed in pancreatic adenocarcinoma post-surgery to reduce the risk of cancer recurrence and in stomach, esophageal, or gastroesophageal junction cancers either as a component of upfront chemotherapy for inoperable cases or when the cancer is HER2 positive and has spread, but has not previously treated with a capecitabine-containing chemotherapy regimen. These applications highlight capecitabine’s pivotal role in managing diverse cancer types, offering therapeutic options for patients facing these challenging conditions.
Final Note
To improve outcomes against stomach cancer, it is imperative that several lines of treatment be used in combination. To achieve the same chemotherapy and immunotherapy, drugs may be offered at the same time, as this can significantly improve a patient’s chances of overcoming this deadly disease.
