Cogitation about the non-surgical treatment of gastric cancer patients

The causal and symptomatic treatment of patients with gastric cancer is an interdisciplinary task based on the recommendations of the oncoteam, meanwhile special attention must be paid to the patient’s current condition. In Hungary, perioperative (neoadjuvant and adjuvant) chemotherapy, especially radiochemotherapy, are less common methods compare to their expected benefits. The best outcome in treatment of metastatic gastric cancer is expected in the frontline treatment, adding trastuzumab the case of HER2-positive, nivolumab or pembrolizumab for HER2-negative (and PD-L1-positive) to cytostatic therapy. The chemotherapeutic agents include various combinations of fluoropyrimidines cisplatin, carboplatin, off-label used oxaliplatin, and, as well as taxanes. Further options in second-line treatment include ramucirumab and trifluridine-tipiracil in third-line. The authors emphasize the importance of target-based therapy, which provided by the new generation sequencing (indicated in reasonable cases), and take into account tumor-agnostic treatment. They also recommended treatment for special clinical situations (tumor bleeding, peritoneal metastases, elderly, poor general condition). They emphasize that a careful symptomatic therapy should be encouraged not only in terminal cases but also right after existence of the diagnosis, and that in addition beside treating of somatic symptoms, the psychological and social factors must be taken into consideration as well, and also a proper communication with the patients and their families to prevent dissatisfaction in the future.