Gastric cancer (GC) is one of the world's most common cancers. According to Lauren's histological classification gastric cancer is divided into two distinct histological groups-the intestinal and diffuse types. A more recent classification is based on mucin expression and distinguishes 4 types of gastric cancer: the gastric or foveolar type (G-type), the intestinal type (I-type), the gastric and intestinal mixed type (GI-type) and the neither gastric nor intestinal phenotypes (N-type). Risk factors include helicobacter pylori infection, gastric lymphoma, pernicious anemia, inherited cancer syndromes and family history. Tests that examine the gastric and esophagus are used to detect (find) and diagnose gastric cancer. Gastric cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the gastric. Early-stage gastric cancer rarely causes symptoms, and this is one of the reasons gastric cancer is so hard to detect early. Studies in the United States have not found that routine screening in people at average risk for gastric cancer is useful, because this disease is not that common. Six types of standard treatment are used for gastric cancer, such as surgery, chemotherapy, radiation therapy, chemoradiation, targeted therapy and immunotherapy.
Trastuzumab (Herceptin) is a monoclonal antibody, a man-made version of a very specific immune system protein, which targets the HER2 protein. Giving trastuzumab with chemo can help some patients with advanced, HER2-positive stomach cancer live longer than giving chemo alone. This drug only works if the cancer cells have too much HER2, so samples of your tumor must be tested to look for HER2 before starting treatment. Ramucirumab, one standard therapy for unresectable GC, is a monoclonal antibody that binds to a receptor for VEGF which can help slow or stop the growth and spread of cancer. Cetuximab is an IgG1 monoclonal antibody that inhibits ligand binding to the EGFR and stimulates cell-mediated cytotoxicity. Nimotuzumab is a recombinant humanized monoclonal immunoglobulin G1 antibody that acts against human EGFR and blocks the binding of EGF and transforming growth factor-α to EGFR. This mechanism inhibits cancer-cell proliferation, angiogenesis, and induces apoptosis. Apatinib is a small-molecule tyrosine kinase inhibitor (TKI) that highly selectively binds to and strongly inhibits VEGFR2 and decreases the VEGF-mediated endothelial cell migration, proliferation, and tumor microvascular density. Regorafenib is an oral multikinase inhibitor, targeted angiogenic (VEGFR1, VEGFR2, and TIE2), stromal and oncogenic receptor tyrosine kinases. Immunotherapies are being verified as potential therapies. Pembrolizumab is a selective, humanized, high-affinity IgG4κ monoclonal antibody designed to bind to PD-1 and block interactions between PD-1 and its ligands. By blocking PD-1, this drug with manageable toxicity profile and effective antitumor activity boosts the immune response against cancer cells.
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