Stomach Cancer Chemotherapy

Introduction

Stomach cancer or gastric cancer continues to be among the top reasons for cancer death worldwide, most notably in Asia and Eastern Europe. Although surgery is usually the mainstay of treatment, chemotherapy for stomach cancer is important for decreasing tumor size, preventing relapse, and extending survival. Chemotherapy precedes, follows, or replaces surgery, depending on the stage and extent of the disease. This article provides a comprehensive review of chemotherapy in stomach cancer—its forms, indications, drug regimens, efficacy, side effects, worldwide costs, and clinical trials in China.

About the Disease

Stomach cancer develops from the lining of the stomach and is usually an adenocarcinoma. Risk factors include:

• Helicobacter pylori infection
• Chronic gastritis
• Smoking and alcohol
• Diet high in smoked and salty foods
• Genetic predispositions (e.g., CDH1 mutation)

Stomach cancer is often diagnosed at an advanced stage due to non-specific symptoms like indigestion, bloating, weight loss, and abdominal pain.

The disease is staged as:

• Early-stage: Confined to the inner lining
• Locally advanced: Invasion into muscle and nearby lymph nodes
• Metastatic: Spread to distant organs like liver, lungs, or peritoneum

Chemotherapy becomes essential in locally advanced and metastatic stages.

Indications for Chemotherapy

Chemotherapy is used in stomach cancer for various reasons:

• Neoadjuvant chemotherapy: Given before surgery to shrink tumors.
• Adjuvant chemotherapy: Given after surgery to destroy remaining cancer cells.
• Concurrent chemoradiation: For better local control.
• Palliative chemotherapy: In metastatic disease to prolong survival and relieve symptoms.

Chemotherapy may be used as the primary treatment in inoperable or recurrent cases.

Treatment Details

Chemotherapy is administered in cycles, typically every 2 or 3 weeks, over several months depending on the protocol and patient’s response.

Modes of administration:

• Intravenous (IV): Most common method using infusion pumps.
• Oral chemotherapy: Available for some agents like capecitabine.

Duration:

• Each cycle: 21–28 days
• Total duration: 4–6 months depending on treatment intent

Patients are usually treated as outpatients unless complications require hospitalization. Chemotherapy is often used in combination with targeted therapies and immunotherapy in advanced disease.

Medicines Used

Multiple chemotherapy drugs are used in various combinations. Common agents include:

1. Fluoropyrimidines

• 5-Fluorouracil (5-FU): Often combined with other drugs.
• Capecitabine (Xeloda): Oral form of 5-FU.

2. Platinum-based Agents

• Cisplatin
• Oxaliplatin

3. Taxanes

• Docetaxel
• Paclitaxel

4. Anthracyclines

• Epirubicin

5. Irinotecan

• Used in second-line regimens or clinical trials.

Common Chemotherapy Regimens:

• FLOT: 5-FU, leucovorin, oxaliplatin, docetaxel
• ECF: Epirubicin, cisplatin, 5-FU
• DCF: Docetaxel, cisplatin, 5-FU
• XELOX: Capecitabine, oxaliplatin

Targeted Therapy Additions:

• Trastuzumab (HER2-positive tumors)
• Ramucirumab (anti-VEGF agent)

Effectiveness

Chemotherapy significantly improves survival and quality of life in patients with stomach cancer. Clinical benefits include:

• Tumor size reduction (important before surgery)
• Elimination of micrometastatic disease after surgery
• Improvement in symptoms such as pain and bleeding
• Increased overall and progression-free survival in advanced stages

FLOT regimen has become the new standard in perioperative settings, showing better outcomes than older ECF regimens.

Risks and Side Effects

Chemotherapy drugs act on fast-growing cells and therefore affect both cancerous and healthy tissues. Side effects vary depending on the regimen but may include:

Common Side Effects:

• Nausea and vomiting
• Diarrhea or constipation
• Fatigue
• Loss of appetite
• Hair loss
• Mouth sores
• Low blood cell counts (increased infection risk)

Serious or Rare Side Effects:

• Peripheral neuropathy (tingling in hands and feet)
• Kidney or liver dysfunction
• Blood clots
• Heart toxicity (especially with anthracyclines)

Most side effects are manageable with supportive medication and careful monitoring.

Recovery and Aftercare

During chemotherapy:

• Regular monitoring through blood tests and imaging
• Management of side effects with supportive medications
• Nutritional counseling

Post-chemotherapy care:

• Gradual return to normal activities
• Management of long-term side effects
• Regular follow-up every 3–6 months with imaging and tumor marker tests

Recovery depends on the regimen used, the cancer stage, and patient comorbidities. Most patients resume full activities within weeks to months after completing chemotherapy.

Cost and Availability

Chemotherapy for stomach cancer is widely available across the globe, especially in cancer centers and tertiary hospitals. The cost varies significantly based on country, hospital type, and drug selection.

In India:

• Each cycle: ₹30,000 – ₹100,000 ($360 – $1,200)
• Full course: ₹2.5 – ₹8 lakhs ($3,000 – $9,600)

In China:

• Each cycle: ¥5,000 – ¥12,000 ($700 – $1,700)
• Full treatment cost: ¥40,000 – ¥100,000 ($5,600 – $14,000)

Public hospitals and government programs often provide subsidized treatment. Some insurance policies may also cover the cost partially or fully.

Patient Experiences

Patient stories highlight the ups and downs of undergoing chemotherapy for stomach cancer.

• “I was worried at first, but my tumor shrunk enough for surgery after 4 cycles of FLOT.”
• “Nausea was rough initially, but the support team really helped me push through.”
• “I went from being bedridden to walking and eating normally after just a few sessions.”

Emotional and psychological support, combined with nutritional guidance, makes a significant difference in patient outcomes and overall experience.

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

These costs include drugs, hospital visits, lab work, and supportive medications.

List of Ongoing Clinical Trials in China

China is a global hub for clinical trials in stomach cancer, especially given the high prevalence and government focus on cancer innovation.

Noteworthy Trials:

1. FLOT vs SOX Neoadjuvant Trial
   • Focus: Comparing effectiveness before surgery
   • Status: Phase III
2. Trastuzumab + Chemotherapy
   • For HER2-positive stomach cancer
   • Status: Phase II/III
3. Checkpoint Inhibitors + Chemotherapy
   • Evaluating immune response and survival benefits
   • Status: Phase II
4. Liquid Biopsy-Guided Chemo Selection
   • Real-time personalization of therapy
   • Status: Phase II
5. Chinese Herbal Medicine + Capecitabine
   • Aim: Reduce side effects and boost outcomes
   • Status: Phase II

Top research centers: Fudan University Shanghai Cancer Center, Peking University Cancer Hospital, and Sun Yat-sen University Cancer Center.

FAQ

Is chemotherapy always necessary for stomach cancer?

Not always. It depends on the stage. Early-stage cancers may be treated with surgery alone, but advanced stages usually require chemo.

How long is chemotherapy for stomach cancer?

Usually 4–6 months, depending on regimen and response.

Can chemotherapy cure stomach cancer?

It can cure in combination with surgery for early and some locally advanced stages. In metastatic cases, it helps prolong life.

Are there oral chemotherapy options?

Yes. Capecitabine is an oral version of 5-FU, commonly used in outpatient settings.

Can I work during chemotherapy?

It depends on the side effects and your energy levels. Many patients reduce their workload or take leave during treatment.

Is chemotherapy available in India and China?

Yes. Both countries offer standard and advanced chemotherapy protocols at affordable rates, especially in government hospitals.