Gastric cancer biology and aetiology

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Published: 20 Dec 2016
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Prof Florian Lordick - University Cancer Centre Leipzig, Germany

Prof Lordick speaks with ecancertv at the Immuno-Oncology Hong Kong 2016 meeting about the classifications of gastric cancer, and how they might inform treatment.

He outlines known biomarkers for patient subtyping, and considers when sequential treatment, anti-angiogenic therapy or combination therapies might be best used.

Prof Lordick also introduces the 2019 Gastric Cancer Congress in Prague.

What we really try to do is to understand gastric cancer better and to develop treatments based on gastric cancer biology. What helps us very much is that just two years ago a new molecular classification has been published dividing gastric cancer into four subtypes which we call EBV associated gastric cancer, Epstein-Barr virus, then MSI, microsatellite instable gastric cancer, chromosomal instable gastric cancer and genomically stable gastric cancer. There is a lot of interesting information about biology in this molecular subclassification.

Do you look for these classifications before you treat a new patient?

This is the goal for the future. Currently we have HER2 as an established treatment target so every patient with gastric cancer is assessed for HER2 but I hope that in the near future we will be able also to build treatments based on MSI status, on EBV status, on PD-L1 expression and on other important molecular features.

Do you think the same will happen with gastric cancers as in the colorectal trials?

For gastric cancer we will probably have immunotherapy in the near future. What we do not yet know is for which subtypes this will work the best but MSI is one of the interesting and hot candidates, EBV association is another candidate but there may be other features as well which need to be explored.

What do you see for the future of this field?

For patients with metastatic gastric cancer sequential treatment is the key, like we have seen in other diseases as well. We have just learned that gastric cancer is also a candidate for sequential treatments for getting from first line to second line, probably in the future also to third line, fourth line. What we know is that at the current time point a platin-5FU based treatment is the standard of care for first line, maybe supplemented by anti-angiogenesis or immunotherapy. We are using anti-angiogenic treatment in second line, the combination of ramucirumab and paclitaxel, and hopefully there will be more effective treatment options in the near future.

Could you tell us about the meeting you are organising in 2017?

In 2019 we will have the International Gastric Cancer Congress in Prague in the Czech Republic, which is a neighbour country of Germany. I hope that many people will attend because I’m sure we will have many good and important views on biology, on novel treatment, of multidisciplinary care in this exciting meeting.