Systemic Therapy for Advanced Gastric and Gastro-Esophageal Carcinoma

Guideline Objective:

To provide guidance on the optimal systemic therapies for the treatment of advanced gastric and gastro-esophageal junction (GEJ) carcinoma. Optimal systemic therapies were defined as those that provided improved overall survival and improved quality of life.

Patient Population:

Adult patients (age ≥18 years) with advanced gastric carcinoma or advanced carcinoma of the GEJ. In this patient population, advanced disease is defined as non-resectable disease that is either locally advanced, recurrent, or metastatic.

Intended Guideline Users:

This guideline is intended for use by clinicians and health care providers involved in the management or referral of the target population.

Research Questions:

What are the optimal systemic therapy regimens for the treatment of advanced gastric and GEJ carcinoma when considering survival, adverse events, and quality of life?

1. Based on the clinical outcomes, what is the optimal first-, second-, and third-line regimen for HER2 overexpressing and HER2 non-overexpressing patients with advanced gastric and GEJ carcinoma?
2. Compared with cisplatin or carboplatin, does a chemotherapy regimen containing oxaliplatin demonstrate superior clinical outcomes in patients with advanced gastric or GEJ carcinoma?
3. In patients with advanced gastric or GEJ carcinoma, does the addition of a targeted agent to chemotherapy improve clinical outcomes when compared with chemotherapy alone in any line of therapy?
4. Compared with chemotherapy or best supportive care, do ICIs improve clinical outcomes in any line of therapy?