Chemotherapy is the cornerstone of gastric cancer treatment, but not all patients have results after chemotherapy, and not all patients can follow the standardized process to complete all treatments. As treatment continues, patients with gastric cancer relapse or fail to tolerate the toxic side effects of chemotherapy, often resulting in chemotherapy failure.
What factors can cause chemotherapy to fail?
Patient factors
Patients with poor hematopoietic function of their own bone marrow, poor general status due to disease progression, etc., or inadequate function of other vital organs (e.g., heart, liver, kidney, lung, etc.) may not be able to tolerate adequate amounts and courses of chemotherapy.
Tumor factors
Tumors themselves are too large and resistant to chemotherapy drugs either primary (tumor does not respond to the drug from the beginning to the end) or secondary (good response to the drug at the beginning of treatment and a reduced response later) due to factors such as tumor histologic features, tumor genetics, and molecular biology. Chemotherapy will destroy sensitive tumor cells, but resistant cells begin to proliferate.
Irrational chemotherapy strategy
Gastric cancer is extremely heterogeneous, with different patients or different cancer cell populations in the same lesion responding to treatment in very different ways. Thus, some patients respond well to the same treatment regimen, while others experience disease progression after 1 to 2 weeks of chemotherapy. If chemotherapeutic agents are not selective for tumors (i.e., their ability to specifically identify and kill tumors), they are often ineffective or less effective against slow-growing or tentatively resting gastric cancer cells.
In addition, inappropriate dosing, route of administration, and duration of chemotherapy may also lead to chemotherapy failure.
Gastric cancer cells enter the “sanctuary”
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“Refuges” are parts of the body, such as the brain, that cannot be easily treated. Stomach cancer cells enter the “sanctuary” when they cross the barrier between the blood and the brain (the blood-brain barrier, which prevents certain substances, mostly harmful ones, from entering the brain from the blood) and move to the brain. Most anti-cancer drugs cannot cross the blood-brain barrier, so it is difficult to treat cancer cells that have entered the “sanctuary”, resulting in chemotherapy failure.
How to deal with chemotherapy failure?
How to deal with chemotherapy failure?
- Choose the right treatment regimen to reduce drug resistance. Doctors usually use alternating, adequate doses of chemotherapy regimens that are not cross-resistant to each other to reduce the development of drug resistance.
- Aggressive improvement of general condition and symptomatic supportive therapy. For patients with poor bone marrow hematopoiesis, physicians usually give colony-stimulating factor (CSF) to stimulate bone marrow growth and differentiation. In patients with organ insufficiency, physicians will try to avoid drugs that are toxic to the damaged organs, for example, platinum drugs will not be used in patients with renal insufficiency.
- Improving health and strengthening immunity can help reduce the risk of tumor recurrence from failed chemotherapy by.
- Develop a scientific nutritional regimen to avoid nutritional deficiency or overnutrition;
- Pay attention to psychological guidance and maintain a good psychological state;
- Perform moderate amount of aerobic exercise.
- Develop a scientific nutritional regimen to avoid nutritional deficiency or overnutrition;
- Pay attention to psychological guidance and maintain a good psychological state;
- Perform moderate amount of aerobic exercise.
- Once disease progression (emergence of drug resistance) is determined, physicians will usually rework the dosing regimen and, if necessary, perform a secondary biopsy of the progressing or new lesion to further refine genetic testing for the best treatment option. Treatment options usually include changing chemotherapy regimens, adding targeted therapeutics, applying immunotherapy, and participating in clinical trials.
- Gastric cancer has a complex etiology, and chemotherapy alone is difficult to achieve optimal results. Multidisciplinary therapy (MDT), which focuses on individualized treatment and comprehensive treatment, is gradually becoming an important tool in the treatment of gastric cancer. When chemotherapy fails, doctors may turn to MDT to provide treatment through joint diagnosis and joint treatment by multidisciplinary experts.
Summary
There are many reasons for chemotherapy failure, including the patient’s own reasons, the tumor itself, and the treatment strategy. In addition to improving the patient’s basic condition, symptomatic supportive treatment, and choosing a reasonable treatment plan, doctors may also use a multidisciplinary expert joint diagnosis and treatment approach to cope with chemotherapy failure, taking into account the patient’s own condition and the characteristics of gastric cancer at different stages. (Contributed by Cheng Yu, Department of Medical Oncology, The First Affiliated Hospital of China Medical University)