Advanced Gastric or Gastro-Esophageal Cancers - Episode 1

Introduction and Global Trends of Gastric Cancer

Transcript: Johanna C. Bendell, MD: Thank you for joining us for this OncLive Peer Exchange® discussion, which features global perspectives regarding the management of advanced gastric or gastroesophageal cancer.

Chemotherapy still plays a significant role in the treatment of advanced gastroesophageal cancers. However, progress with targeted therapies has extended survival and is expanding the options for patients.

Throughout this discussion, our panel of international experts in gastroesophageal cancers will explore the practical application of the most recent data.

I am Dr Johanna Bendell, the chief development officer at Sarah Cannon Research Institute in Nashville, Tennessee.

Participating today on our panel are: Dr David Ilson, [an] attending physician and a professor of medicine at Memorial Sloan Kettering Cancer Center in New York, New York; Dr Manish Shah, an associate professor of medicine and [the] chief of the Solid Tumor Oncology Service at Weill Cornell Medicine, in New York, New York; and Dr Kohei Shitara, the chief of the Department of Gastrointestinal Oncology at the National Cancer Center Hospital East in Kashiwa, Japan.

Thank you so much to everybody for joining us today. I’m looking forward to a great discussion. Maybe what we can do is set a place for the discussion to begin in talking a little about the global trends in gastric cancers. Manish, how are we looking at the incidence, type, and prognosis of gastroesophageal cancers, and how does that differ around the world?

Manish A. Shah, MD: Gastric cancers remain a significant worldwide global problem. Nearly 1 million people a year are diagnosed worldwide. There is significant heterogeneity across the globe. In the United States, about 40,000 patients a year are diagnosed. It’s much more prevalent in Eastern Europe, Asia, and South America. There is an association with some factors, like H pylori [Helicobacter pylori]. Diffuse gastric cancer, which I know we’ll talk about a little bit later, is actually uniform across the globe. One thing that’s interesting is that we have made progress in treatment survival. At least in the United States, the 5-year survival was about 15%. Now it’s up to 30%. That’s with a lot of the advances that we’ll talk about today, but the disease is declining in the United States overall.

Johanna C. Bendell, MD: You mentioned H pylori. A question I get from referring oncologists is, “If you see a patient who’s diagnosed with gastric cancer and the gastroenterologist found they had H pylori, do you treat it?”

Manish A. Shah, MD: Yeah, I think it does make sense to treat it. An active infection of H pylori can lead to increased inflammation and that sort of thing. It doesn’t actually have any impact on how well we can treat the cancer itself, but there’s no need to have active gastritis on top of a cancer.

David H. Ilson, MD, PhD: I think another important point is to screen family members, because the infection can track in other family members. Household contacts need to be tested and treated as well. We know that treating the Helicobacter infection does reduce the future risk of developing gastric cancer from Japanese data.

Johanna C. Bendell, MD: What about in Japan? Is it as prevalent in Japan?

Kohei Shitara, MD: Yeah, gastric cancer is still a leading cause of cancer there, or second cause of cancer in Japan. There are still 15,000 patient deaths from gastric cancer in Japan. Screening is a standard procedure in Japan, so maybe we can pick up the patient earlier than other countries. But still, 30% of patients are diagnosed with stage III or stage IV, very advanced disease. So to treat the gastric cancer is very important. Helicobacter pylori is very common in Japan—approximately 80% in elderly patients and 40% in younger patients. Eradication is a controversial area because several randomized studies tried to assess the impact of eradication after ESD [endoscopic submucosal dissection] treatment for gastric cancer. Even in Japan, we do not usually do eradication for all patients, but we do eradication for patients who had a previous gastric disease, such as an ulcerated lesion.

Manish A. Shah, MD: I would agree with that. One thing to point out is that H pylori is an endemic pathogen. Half the world’s population has H pylori. But only 1% of the world’s population, if that, maybe 0.1%, actually gets gastric cancer. So a significant proportion of patients who have H pylori won’t get gastric cancers, so don’t…

Johanna C. Bendell, MD: Don’t worry about it.

Manish A. Shah, MD: Don’t worry so much.

Transcript Edited for Clarity