Drug treatment for advanced/metastatic gastric cancer

Background: More than one-third of newly diagnosed gastric adenocarcinomas are metastatic and continue to have a poor prognosis. Palliative systemic therapy is the treatment option of choice.Objectives: To explain current therapeutic standards in palliative chemotherapy for metastatic gastric adenocarcinoma and to point out new therapeutic strategies.Materials and methods: Presentation of current guideline-based therapy, analysis of recent publication results and discussion of new therapy options.Results: Fluorouracil- and platinum-containing chemotherapy represents the therapy of choice for newly diagnosed metastatic gastric cancer. Depending on the molecular pathology of the tumor, therapy should be combined with checkpoint inhibition (nivolumab) or HER2-targeted therapy (trastuzumab). In the second- and third-line setting, effective therapeutic options are available and are selected depending on the patient's general condition, molecular pathology, and prior therapy. New targeted therapies (against FGFR2 or CLDN 18.2) may prove to be effective in the future.Conclusion: With current sequential systemic therapies, patients receive effective palliative treatment in metastatic gastric cancer, which significantly improves prognosis. Therapy should be adapted to the molecular pathology of the tumor. New targets for further therapies are the subject of research.