Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern...Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern countries.The survival in advanced and metastatic stage of gastric cancer is still very poor.Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients.Indeed,the key point is still the selection of patients for the right treatment,on basis of molecular tumor characterization.Since chemotherapy reached a plateau of efficacy for gastric cancer,the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity.Currently,Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erb B2 positive patients,whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer.New perspectives for an effective treatment derived from the immunotherapeutic strategies.Here,we report an overview on gastric cancer treatments,with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.展开更多
Over 50% of patients diagnosed with non-smallcell lung cancer(NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to pro...Over 50% of patients diagnosed with non-smallcell lung cancer(NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to progressive reduction of organ function and age-related co-existing pathologies. Due to this reason elderly are usually excluded from platinum-based chemotherapy, which still represent the standard of care for advanced NSCLC. In every-day practice, single-agent schedule with a third-generation drug is the recommended option for elderly patients with advanced NSCLC. A modest increase in toxicity for elderly patients has been demonstrated by subgroup analyses concluding for platinum-based combination chemotherapy being similar in young patients and fit elderly. Even though the cited evidence, feasibility of chemotherapy based on platinum remains an open question. Prospective randomised trials are warranted in order to change guide lines and give the clinicians a new therapeutic option. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials for elderly patients. The same is for more accurate evaluation of elderly patients with increasing evidence for a comprehensive geriatric assessment as a valid tool for customized treatment in NSCLC elderly patients. Suitable evidences for the treatment of elderly patients affected by advanced NSCLC together with more appropriate and validated tools for patients selection are reviewed along the manuscript.展开更多
基金Supported by CRT Foudationand by the Italian Ministry of Health:Ricerca Sanitaria Finalizzata e Giovani Ricercatori 2009,No.GR 2009-1584485
文摘Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern countries.The survival in advanced and metastatic stage of gastric cancer is still very poor.Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients.Indeed,the key point is still the selection of patients for the right treatment,on basis of molecular tumor characterization.Since chemotherapy reached a plateau of efficacy for gastric cancer,the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity.Currently,Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erb B2 positive patients,whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer.New perspectives for an effective treatment derived from the immunotherapeutic strategies.Here,we report an overview on gastric cancer treatments,with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.
文摘Over 50% of patients diagnosed with non-smallcell lung cancer(NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to progressive reduction of organ function and age-related co-existing pathologies. Due to this reason elderly are usually excluded from platinum-based chemotherapy, which still represent the standard of care for advanced NSCLC. In every-day practice, single-agent schedule with a third-generation drug is the recommended option for elderly patients with advanced NSCLC. A modest increase in toxicity for elderly patients has been demonstrated by subgroup analyses concluding for platinum-based combination chemotherapy being similar in young patients and fit elderly. Even though the cited evidence, feasibility of chemotherapy based on platinum remains an open question. Prospective randomised trials are warranted in order to change guide lines and give the clinicians a new therapeutic option. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials for elderly patients. The same is for more accurate evaluation of elderly patients with increasing evidence for a comprehensive geriatric assessment as a valid tool for customized treatment in NSCLC elderly patients. Suitable evidences for the treatment of elderly patients affected by advanced NSCLC together with more appropriate and validated tools for patients selection are reviewed along the manuscript.
