Revised 07 January 2013

Treatment options are based on current evidence

Stage 0 

Cancer is limited to mucosa without invasion of the lamina propria

• Gastrectomy and lymphadenectomy

    Stage IA: T1 N0, M0

• Surgical resection including D1 regional lymphadenopathy
• No role for adjuvant chemotherapy or radiotherapy

Stage IB - Stage IIIC

• Perioperative chemotherapy (GIGECC, GIGECF) with surgical resection and D1 regional lymphadenectomy
• Surgical resection and D1 regional lymphadenectomy followed by adjuvant chemoradiation (GIGAIRT)
• Postoperative -adjuvant chemotherapy alone may be an option for selected patients with node-negative disease following a D2 resection who are not candidates for adjuvant chemoradiation (UGIGAJCC)
• Consider treatment on a clinical trial, if available.

Stage IV: any T, any N, M1 (Unresectable, recurrent, or metastatic disease)

• Palliative radiation therapy may be given to relieve dysphagia, obstruction or bleeding
• Surgical resection or bypass of obstructing or bleeding primary lesions in selected patients
• Palliative chemotherapy may be given to help improve symptoms and quality of life, and extend survival in appropriately selected patients.
• Currently approved chemotherapeutic agents for advanced gastric carcinoma (HER2 negative) include: 5-fluorouracil (5-FU), capecitabine, cisplatin, epirubicin, docetaxel, and irinotecan.
  • The most commonly used regimens are:
    • 5-FU and cisplatin (GIFUC)
    • Epirubicin, cisplatin and 5-FU (ECF) or capecitabine (ECC)
    • 5-FU and irinotecan (FOLFIRI)
  • The choice and sequence of chemotherapy is determined by disease-related factors, patient factors and patient preferences as assessed by the medical oncologist.
• In 20-25% of patients with gastroesophageal junction/gastric adenocarcinoma, there is tumour over-expression of the HER2 protein. Patients with HER2 2+/FISH+ or 3+ disease may benefit from the addition of the targeted agent trastuzumab.
  • The most commonly used regimen combines trastuzumab with cisplatin, and 5-FU (UGIGAVCFT) or capecitabine (UGIGAVCCT)
• Patients who are responding after 6 cycles of chemotherapy with trastuzumab may continue with maintenance single agent trastuzumab (UGIGAVTR) until disease progression.

Please refer to current treatment protocols for indications, dosing and eligibility criteria.

Consider treatment on a clinical trial, if available.

Symptom management, best supportive care, and involvement of palliative care services as indicated by patient’s clinical status.