Clinical process of drug treatment for gastric cancer
Drug therapy for patients with gastric cancer is divided into three main steps.
The first step is the fundamental decision of whether to use the drug or not, and what are the indications;
The second step is how to use the drug, what drug to use, and what route of drug delivery to choose;
The third step is to stop or continue the medication if the patient’s condition has changed after the medication has been started.
Determinants of tumor treatment and prognosis
There are three things: 1, tumor biological behavior; 2, patient’s physical condition; 3, economic and social support.
The philosophy of drug treatment for gastric cancer
One of them is: firstly, the overall clinical decision is made.
How to make it is divided into
1, patient and tumor condition;
2, overall strategy;
3, selection of drugs;
4, Judgment of surgery;
5, local treatment;
6, follow up model.
Such a decision-making system, to give a specific example, should be like the following –
The second is: the pursuit of precision medicine under the premise of standardized treatment
The domestic norms that can be referred to are: the diagnosis and treatment norms for gastric cancer of the Health Planning Commission (2010 and 2015 editions); the NCCN guidelines for gastric cancer – Chinese edition (2007-2012, 2016); and the CSCO guidelines (2016.4.23).
Foreign referable norms are: JGCA statute, Korea, Taiwan; NCCN guidelines; ESMO, NICE in Europe.
What does our clinical thinking look like?
Gastric cancer → gastric cancer with liver metastasis → Lauren staging → HER2 positive/negative → others?Cmet, EGFR, PDL1?→ molecular staging?
The first 4 steps are what all medical oncologists can think of, whether they are residents or chief physicians, but the last two steps make a difference.
The last step of molecular typing is the real precision treatment, which involves the biological behavior of tumor, but the least doctors have gone to this step in clinical thinking.
The value of proper understanding of molecular typing.
The third one is: balancing clinical research and clinical practice
Firstly, clinical studies should be rationalized, for example, a HER2-positive gastric cancer with progression in trastuzumab treatment can be divided into clinical studies of trastuzumab continued after progression and other anti-HER2 treatments.
Secondly, the data of clinical studies should be interpreted reasonably, and the data interpretation of clinical studies should be combined with clinical practice applications.
In conclusion, gastric cancer drug therapy should firstly go into the maximum possible to determine tumor biological behavior, precise tumor assessment, predict progression site and consequence and carry out predictive treatment, which requires clear goals and reasonable treatment pacing.