Gastric Cancer Chemotherapy

Introduction

Stomach cancer, also known as gastric cancer, is still one of the most common causes of cancer mortality globally. It is difficult to detect early because the symptoms are nonspecific. Therefore, chemotherapy becomes an essential part of treatment, especially in cases of locally advanced and metastatic disease. Gastric cancer chemotherapy is the administration of strong drugs to destroy or inhibit the growth of cancer cells. This article gives a comprehensive summary of indications, medicines, efficacy, worldwide costs, and clinical trials in progress—particularly in China, where advances in treatment are changing at a pace.

About the Disease

Gastric cancer begins in the inner lining of the stomach and can spread to nearby organs or distant sites. The most common type is adenocarcinoma, which originates in the glandular tissue of the stomach lining. Risk factors include:

• H. pylori infection

• High salt intake

• Smoking and alcohol use

• Genetic mutations

• Chronic gastritis

Symptoms usually appear in later stages and include indigestion, loss of appetite, weight loss, nausea, and stomach pain.

Staging determines treatment options and is classified as:

• Localized (confined to the stomach)

• Locally advanced (spread to nearby tissues)

• Metastatic (spread to distant organs)

Indications for Chemotherapy

Chemotherapy may be used for gastric cancer in the following settings:

• Neoadjuvant chemotherapy: Before surgery to shrink tumors

• Adjuvant chemotherapy: After surgery to eliminate residual cells

• Concurrent chemoradiation: Combined with radiotherapy

• Palliative chemotherapy: In advanced or metastatic disease to prolong life and control symptoms

Early-stage cancer patients typically don’t use it unless the tumor exhibits aggressive features.

Treatment Details

Gastric cancer chemotherapy may be delivered in cycles, combining two or more drugs. The treatment settings include:

• Outpatient chemotherapy: Most common, patients return home after infusion

• Inpatient chemotherapy: For intensive regimens or patients with complications

Each cycle lasts about 2–3 weeks, and the full course includes 4–8 cycles depending on response and patient tolerance.

Modes of administration:

• Intravenous infusion (most common)

• Oral chemotherapy (in some targeted regimens)

Chemotherapy is often combined with targeted therapy or immunotherapy in advanced stages for better outcomes.

Medicines Used

Several chemotherapeutic agents are used in various combinations for treating gastric cancer. Common regimens include:

1. Fluoropyrimidines

• 5-Fluorouracil (5-FU): Backbone of many regimens

• Capecitabine: Oral version of 5-FU

2. Platinum Agents

• Cisplatin and Oxaliplatin: Often combined with fluoropyrimidines

3. Taxanes

• Docetaxel and Paclitaxel: Used in advanced or recurrent disease

4. Anthracyclines

• Epirubicin: Used in ECF (epirubicin-cisplatin-fluorouracil) regimen

5. Irinotecan

• Used in salvage or second-line therapy

Common Regimens:

• FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)

• XELOX (capecitabine + oxaliplatin)

• DCF (docetaxel, cisplatin, 5-FU)

Targeted Therapy Additions:

• Trastuzumab: For HER2-positive gastric cancers

• Ramucirumab: VEGF inhibitor used in advanced cases

Effectiveness

Chemotherapy significantly improves outcomes in both localized and advanced gastric cancer:

• Neoadjuvant chemotherapy improves surgical success and long-term survival.

• Adjuvant chemotherapy reduces recurrence risk post-surgery.

• In metastatic disease, it prolongs survival and provides symptom relief.

• Overall response rates vary from 30–60%, depending on drug combinations.

The FLOT regimen has shown superior results in the perioperative setting compared to older regimens like ECF.

Risks and Side Effects

Chemotherapy targets fast-growing cells, including some healthy ones. Common side effects include:

• Nausea and vomiting

• Diarrhea

• Hair loss

• Loss of appetite

• Fatigue

• Mouth sores

• Low blood counts (anemia, neutropenia, thrombocytopenia)

Serious but less frequent complications:

• Kidney or liver damage

• Peripheral neuropathy (tingling in hands and feet)

• Risk of infection

• Mucositis and ulcers

Most side effects are temporary and can be managed with medications and supportive care.

Recovery and Aftercare

Recovery varies depending on the chemotherapy regimen and patient condition.

During chemotherapy:

• Regular blood tests and imaging

• Monitoring side effects

• Nutritional support

After chemotherapy:

• Lifestyle modifications: balanced diet, exercise, and hydration

• Psychological support and counseling

• Continuous monitoring via endoscopy and imaging

• Periodic tumor marker assessment (CEA, CA 19-9)

Patients may need 4–6 weeks to regain normal function after completing chemotherapy.

Cost and Availability

Gastric cancer chemotherapy is widely available in both public and private hospitals around the world. Costs depend on:

• Drug regimen used

• Number of cycles

• Hospital charges and geographic location

In India:

• Public hospitals: ₹30,000 – ₹70,000 ($350–$850) per cycle

• Private hospitals: ₹60,000 – ₹150,000 ($750–$1,800) per cycle

In China:

• ¥5,000 – ¥12,000 ($700–$1,700) per cycle

• Targeted therapies like trastuzumab may cost ¥20,000+ ($2,800) per cycle

Government schemes and insurance often subsidize treatment in both countries.

Patient Experiences

Many patients report mixed experiences with chemotherapy—while it is physically and emotionally taxing, it also provides a path to remission or control of symptoms.

Patient quotes:

• “FLOT was tough, but I’m alive and cancer-free 3 years later.”

• “Side effects were bad in the beginning, but my body adjusted.”

• “I got my energy back slowly, and my tumor shrunk after 3 cycles.”

Support groups and survivorship programs greatly improve overall experience.

Cost in Countries Like China, India, Israel, Malaysia, Korea, Thailand, Turkey, and USA

Costs include chemotherapy drugs, infusion charges, labs, and supportive care.

List of Ongoing Clinical Trials in China

China is among the global leaders in gastric cancer research, particularly due to the high incidence in East Asia. Ongoing trials include:

1. FLOT vs SOX Regimen Trial

   • Aim: Comparing effectiveness in neoadjuvant settings

   • Status: Phase III

2. Trastuzumab + Pembrolizumab Combination

   • For HER2-positive advanced gastric cancer

   • Status: Phase II

3. Immunotherapy + Chemotherapy in MSI-H Tumors

   • Aim: Improve progression-free survival

   • Status: Phase III

4. Circulating Tumor DNA-Guided Chemotherapy Selection

   • Aim: Personalizing regimens based on real-time genetics

   • Status: Phase II

5. Chinese Herbal Medicine + XELOX

   • Aim: Reducing side effects and improving response

   • Status: Phase II

Leading centers: Cancer Hospital Chinese Academy of Medical Sciences (Beijing), Sun Yat-sen University Cancer Center (Guangzhou), and Fudan University Shanghai Cancer Center.

FAQ

Is chemotherapy mandatory for gastric cancer?

Not always. Surgery alone may be sufficient in very early-stage cancer. Chemotherapy is used in locally advanced and metastatic disease.

How many cycles of chemo are given?

Usually 4–8 cycles depending on disease stage and response.

Will I lose hair during gastric cancer chemotherapy?

Yes, drugs like docetaxel or epirubicin can cause hair loss. It usually regrows after treatment ends.

Is oral chemotherapy available?

Yes, capecitabine is an oral alternative to IV 5-FU.

Can I work during chemotherapy?

Light duties may be possible depending on side effects. Many patients take time off during treatment.

Is chemotherapy available in India and China?

Yes, widely available in public and private cancer centers with a range of costs and access to global regimens.