A multidisciplinary approach is mandatory for patients with
gastric cancer. Patients should be managed by an experienced team of physicians. The outcome of patients is related to the experience of the multidisciplinary team. Surgery is the cornerstone of the management of patients with resectable
gastric cancer. The standard recommendations for resectable gastric
adenocarcinoma are free-margin surgery with at least D1 resection combined to removal of a minimum of 15 lymph nodes. It has been shown that the outcome of patients with resectable
gastric cancer can be improved by a strategy of perioperative (pre- and postoperative)
chemotherapy or by postoperative
chemoradiotherapy. The evidence comes from large randomised phase 3 studies. In the treatment of unresectable, locally advanced or metastatic gastric or gastro-oesophageal junction
adenocarcinoma, no
chemotherapy combination was accepted as the gold standard.
Cisplatin/5-FU (CF) and ECF (
epirubicin plus CF) regimens have been investigated widely in clinical studies and were until recently presented as the reference regimens. Despite a relative chemosensitivity of
gastric cancer, a low rate of complete response was obtained, the response duration was short and patients' outcomes remained poor. Recently, new options have been introduced in the management of advanced
gastric cancer. It has been shown that
capecitabine is at least as good as
5-FU and that
oxaliplatin at least as good as
cisplatin in these combinations. It has also been demonstrated that the addition of
docetaxel to CF resulted in statistically significant improved efficacy endpoints (including patient's quality of life), but also in an increased toxicity. The DCF regimen (
docetaxel,
cisplatin and 5-FU) has become, therefore, a new active option in advanced
gastric cancer in selected patients in good condition. Further randomised trials are therefore to be designed to further improve
chemotherapy by modifying and optimising the
chemotherapy regimens, and investigating novel treatment combinations. The addition of
biological agents to the optimal
chemotherapy regimen may achieve further improvements in efficacy.