Research progress on conversion chemotherapy of stage <b>Ⅳ</b> gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Yi ¹ , LIU Jiangtao ¹ ,  WANG Zhengbing ²

1. Gastrointestinal Center of Yangzhou University Clinical Medical School, Yangzhou, Jiangsu 225001, P. R. China;
2. Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225001, P. R. China;

Corresponding author：

WANG Zhengbing, Email: wzhb403@163.com

Keywords：

stage Ⅳ gastric cancer; initially unresectable; conversion therapy; conversion chemotherapy

DOI：

10.7507/1007-9424.201905021

Video：

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Objective To explore feasibility and security of conversion chemotherapy of stage Ⅳ gastric cancer.Method The research progresses of conversion chemotherapy of stage Ⅳ gastric cancer were summarized by reading relevant literatures.Results The prognosis of stage Ⅳ gastric cancer was poor, its correct treatment strategy was still controversial. At present, the palliative chemotherapy and targeted therapy were mainly used for it. In recent years, the development of chemotherapeutic drugs had improved the survival of some patients who showed the excellent chemotherapy response rate and subsequently undergone surgery, which promoted the derivation of the concept of conversion therapy. For the patients with initial unresectable stage Ⅳ gastric cancer, these patients could get better pathological reaction and then perform R0 operation through the comprehensive measures such as the preoperative chemotherapy, so that the patients could acquire relatively longer survival time. The previous studies indicated that the single unresectable factor, chemotherapy response rate, and whether R0 resection were the important predictors of prognosis for patients with stage Ⅳ gastric cancer.Conclusions Conversion therapy is still at initial stage. Different conversion chemotherapy regime has different response rate. Moreover, expert consensus on case selection, chemotherapy regimen are absent due to lack of high-quality, multi-center, large-sample data. So higher levels of clinical randomized controlled trials are needed to support and guide this practice. In a word, conversion therapy of stage Ⅳ gastric cancer requires multi-disciplinary efforts to carry out an optimal classification to select out suitable candidates, which may provide efficient guidance for comprehensive treatment for stage Ⅳ gastric cancer.

Citation： LUO Yi, LIU Jiangtao, WANG Zhengbing. Research progress on conversion chemotherapy of stage Ⅳ gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1490-1494. doi: 10.7507/1007-9424.201905021 Copy

1.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
2.	Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
3.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
4.	Ajani JA, D’Amico TA, Almhanna K, et al. Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2016, 14(10): 1286-1312.
5.	Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase Ⅲ trial. Lancet Oncol, 2008, 9(3): 215-221.
6.	Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase Ⅲ study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol, 2006, 24(31): 4991-4997.
7.	Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med, 2008, 358(1): 36-46.
8.	Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol, 2016, 17(3): 309-318.
9.	Cascinu S, Scartozzi M, Labianca R, et al. High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD). Br J Cancer, 2004, 90(8): 1521-1525.
10.	Nakajima T, Ota K, Ishihara S, et al. Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol, 1997, 4(3): 203-208.
11.	Yano M, Shiozaki H, Inoue M, et al. Neoadjuvant chemotherapy followed by salvage surgery: effect on survival of patients with primary noncurative gastric cancer. World J Surg, 2002, 26(9): 1155-1159.
12.	Satoh S, Okabe H, Teramukai S, et al. Phase Ⅱ trial of combined treatment consisting of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for stage Ⅳ gastric cancer. Gastric Cancer, 2012, 15(1): 61-69.
13.	Kanda T, Yajima K, Kosugi S, et al. Gastrectomy as a secondary surgery for stage Ⅳ gastric cancer patients who underwent S-1-based chemotherapy: a multi-institute retrospective study. Gastric Cancer, 2012, 15(3): 235-244.
14.	Han DS, Suh YS, Kong SH, et al. Outcomes of surgery aiming at curative resection in good responder to induction chemotherapy for gastric cancer with distant metastases. J Surg Oncol, 2013, 107(5): 511-516.
15.	Fukuchi M, Ishiguro T, Ogata K, et al. Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol, 2015, 22(11): 3618-3624.
16.	Sato Y, Ohnuma H, Nobuoka T, et al. Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study. Gastric Cancer, 2017, 20(3): 517-526.
17.	Yamaguchi K, Yoshida K, Tanahashi T, et al. The long-term survival of stage Ⅳ gastric cancer patients with conversion therapy. Gastric Cancer, 2018, 21(2): 315-323.
18.	Thomassen I, van Gestel YR, van Ramshorst B, et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival and risk factors. Int J Cancer, 2014, 134(3): 622-628.
19.	梁寒. 腹腔热灌注化疗技术临床应用专家共识(2016版)解读—胃癌腹膜转移的防治. 临床外科杂志, 2017, 25(1): 20-23.
20.	Kim JG, Ryoo BY, Park YH, et al. Prognostic factors for survival of patients with advanced gastric cancer treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol, 2008, 61(2): 301-307.
21.	Suzuki T, Tanabe K, Taomoto J, et al. Preliminary trial of adjuvant surgery for advanced gastric cancer. Oncol Lett, 2010, 1(4): 743-747.
22.	Okabe H, Ueda S, Obama K, et al. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol, 2009, 16(12): 3227-3236.
23.	Kinoshita J, Fushida S, Tsukada T, et al. Efficacy of conversion gastrectomy following docetaxel, cisplatin, and S-1 therapy in potentially resectable stage Ⅳ gastric cancer. Eur J Surg Oncol, 2015, 41(10): 1354-1360.
24.	梁品, 胡祥. 胃癌腹膜转移诊治策略. 中国实用外科杂志, 2017, 37(10): 1099-1102.
25.	朱正纲. 胃癌腹膜转移转化性治疗的临床意义. 中国肿瘤外科杂志, 2016, 8(4): 213-216.
26.	Yonemura Y, Ishibashi H, Hirano M, et al. Effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy and neoadjuvant intraperitoneal/systemic chemotherapy on peritoneal metastases from gastric cancer. Ann Surg Oncol, 2017, 24(2): 478-485.
27.	Ishigami H, Fujiwara Y, Fukushima R, et al. Phase Ⅲ trial comparing intraperitoneal and intravenous paclitaxel plus S-1 versus cisplatin plus S-1 in patients with gastric cancer with peritoneal metastasis: PHOENIX-GC trial. J Clin Oncol, 2018, 36(19): 1922-1929.
28.	李冬冬, 胡春华, 项洪刚, 等. 胃癌腹膜转移的研究进展. 中国普外基础与临床杂志, 2017, 24(12): 1532-1535.
29.	Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase Ⅲ randomized clinical trial. Ann Surg Oncol, 2011, 18(6): 1575-1581.
30.	Rudloff U, Langan RC, Mullinax JE, et al. Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol, 2014, 110(3): 275-284.
31.	Kataoka K, Kinoshita T, Moehler M, et al. Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG. Gastric Cancer, 2017, 20(5): 904-912.
32.	Okines AF, Ashley SE, Cunningham D, et al. Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for advanced esophagogastric cancer: dose-finding study for the prospective multicenter, randomized, phase Ⅱ/Ⅲ REAL-3 trial. J Clin Oncol, 2010, 28(25): 3945-3950.
33.	Babu KG, Chaudhuri T, Lakshmaiah KC, et al. Efficacy and safety of first-line systemic chemotherapy with epirubicin, cisplatin plus 5-fluorouracil and docetaxel, cisplatin plus 5-fluorouracil regimens in locally advanced inoperable or metastatic gastric or gastroesophageal junction adenocarcinoma: A prospective phase Ⅱ study from South India. Indian J Cancer, 2017, 54(1): 47-51.
34.	Li ZY, Tang L, Zhang LH, et al. Weekly docetaxel and cisplatin plus fluorouracil as a preoperative treatment for gastric cancer patients with synchronous multiple hepatic metastases: a pilot study. Med Oncol, 2010, 27(4): 1314-1318.
35.	Chen L, Song MQ, Lin HZ, et al. Chemotherapy and resection for gastric cancer with synchronous liver metastases. World J Gastroenterol, 2013, 19(13): 2097-2103.
36.	朱正纲. 晚期胃癌转化治疗的理念与临床意义. 外科理论与实践, 2017, 22(1): 1-4.
37.	Gadde R, Tamariz L, Hanna M, et al. Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis. J Surg Oncol, 2015, 112(1): 38-45.
38.	Fujimura T, Nakamura K, Oyama K, et al. Selective lymphadenectomy of para-aortic lymph nodes for advanced gastric cancer. Oncol Rep, 2009, 22(3): 509-514.
39.	Yoshikawa T, Sasako M, Yamamoto S, et al. Phase Ⅱ study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg, 2009, 96(9): 1015-1022.
40.	Tsuburaya A, Mizusawa J, Tanaka Y, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg, 2014, 101(6): 653-660.
41.	Ito S, Sano T, Mizusawa J, et al. A phase II study of preoperative chemotherapy with docetaxel, cisplatin, and S-1 followed by gastrectomy with D2 plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis: JCOG1002. Gastric Cancer, 2017, 20(2): 322-331.
42.	Wang Y, Yu YY, Li W, et al. A phase Ⅱ trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis. Cancer Chemother Pharmacol, 2014, 73(6): 1155-1161.
43.	Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
44.	Roviello F, Pedrazzani C, Marrelli D, et al. Super-extended (D3) lymphadenectomy in advanced gastric cancer. Eur J Surg Oncol, 2010, 36(5): 439-446.
45.	Yoshida K, Yamaguchi K, Okumura N, et al. Is conversion therapy possible in stage Ⅳ gastric cancer: the proposal of new biological categories of classification. Gastric Cancer, 2016, 19(2): 329-338.
46.	Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet, 2010, 376(9742): 687-697.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
2. Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
3. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
4. Ajani JA, D’Amico TA, Almhanna K, et al. Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2016, 14(10): 1286-1312.
5. Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase Ⅲ trial. Lancet Oncol, 2008, 9(3): 215-221.
6. Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase Ⅲ study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol, 2006, 24(31): 4991-4997.
7. Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med, 2008, 358(1): 36-46.
8. Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol, 2016, 17(3): 309-318.
9. Cascinu S, Scartozzi M, Labianca R, et al. High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD). Br J Cancer, 2004, 90(8): 1521-1525.
10. Nakajima T, Ota K, Ishihara S, et al. Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol, 1997, 4(3): 203-208.
11. Yano M, Shiozaki H, Inoue M, et al. Neoadjuvant chemotherapy followed by salvage surgery: effect on survival of patients with primary noncurative gastric cancer. World J Surg, 2002, 26(9): 1155-1159.
12. Satoh S, Okabe H, Teramukai S, et al. Phase Ⅱ trial of combined treatment consisting of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for stage Ⅳ gastric cancer. Gastric Cancer, 2012, 15(1): 61-69.
13. Kanda T, Yajima K, Kosugi S, et al. Gastrectomy as a secondary surgery for stage Ⅳ gastric cancer patients who underwent S-1-based chemotherapy: a multi-institute retrospective study. Gastric Cancer, 2012, 15(3): 235-244.
14. Han DS, Suh YS, Kong SH, et al. Outcomes of surgery aiming at curative resection in good responder to induction chemotherapy for gastric cancer with distant metastases. J Surg Oncol, 2013, 107(5): 511-516.
15. Fukuchi M, Ishiguro T, Ogata K, et al. Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol, 2015, 22(11): 3618-3624.
16. Sato Y, Ohnuma H, Nobuoka T, et al. Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study. Gastric Cancer, 2017, 20(3): 517-526.
17. Yamaguchi K, Yoshida K, Tanahashi T, et al. The long-term survival of stage Ⅳ gastric cancer patients with conversion therapy. Gastric Cancer, 2018, 21(2): 315-323.
18. Thomassen I, van Gestel YR, van Ramshorst B, et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival and risk factors. Int J Cancer, 2014, 134(3): 622-628.
19. 梁寒. 腹腔热灌注化疗技术临床应用专家共识(2016版)解读—胃癌腹膜转移的防治. 临床外科杂志, 2017, 25(1): 20-23.
20. Kim JG, Ryoo BY, Park YH, et al. Prognostic factors for survival of patients with advanced gastric cancer treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol, 2008, 61(2): 301-307.
21. Suzuki T, Tanabe K, Taomoto J, et al. Preliminary trial of adjuvant surgery for advanced gastric cancer. Oncol Lett, 2010, 1(4): 743-747.
22. Okabe H, Ueda S, Obama K, et al. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol, 2009, 16(12): 3227-3236.
23. Kinoshita J, Fushida S, Tsukada T, et al. Efficacy of conversion gastrectomy following docetaxel, cisplatin, and S-1 therapy in potentially resectable stage Ⅳ gastric cancer. Eur J Surg Oncol, 2015, 41(10): 1354-1360.
24. 梁品, 胡祥. 胃癌腹膜转移诊治策略. 中国实用外科杂志, 2017, 37(10): 1099-1102.
25. 朱正纲. 胃癌腹膜转移转化性治疗的临床意义. 中国肿瘤外科杂志, 2016, 8(4): 213-216.
26. Yonemura Y, Ishibashi H, Hirano M, et al. Effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy and neoadjuvant intraperitoneal/systemic chemotherapy on peritoneal metastases from gastric cancer. Ann Surg Oncol, 2017, 24(2): 478-485.
27. Ishigami H, Fujiwara Y, Fukushima R, et al. Phase Ⅲ trial comparing intraperitoneal and intravenous paclitaxel plus S-1 versus cisplatin plus S-1 in patients with gastric cancer with peritoneal metastasis: PHOENIX-GC trial. J Clin Oncol, 2018, 36(19): 1922-1929.
28. 李冬冬, 胡春华, 项洪刚, 等. 胃癌腹膜转移的研究进展. 中国普外基础与临床杂志, 2017, 24(12): 1532-1535.
29. Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase Ⅲ randomized clinical trial. Ann Surg Oncol, 2011, 18(6): 1575-1581.
30. Rudloff U, Langan RC, Mullinax JE, et al. Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol, 2014, 110(3): 275-284.
31. Kataoka K, Kinoshita T, Moehler M, et al. Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG. Gastric Cancer, 2017, 20(5): 904-912.
32. Okines AF, Ashley SE, Cunningham D, et al. Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for advanced esophagogastric cancer: dose-finding study for the prospective multicenter, randomized, phase Ⅱ/Ⅲ REAL-3 trial. J Clin Oncol, 2010, 28(25): 3945-3950.
33. Babu KG, Chaudhuri T, Lakshmaiah KC, et al. Efficacy and safety of first-line systemic chemotherapy with epirubicin, cisplatin plus 5-fluorouracil and docetaxel, cisplatin plus 5-fluorouracil regimens in locally advanced inoperable or metastatic gastric or gastroesophageal junction adenocarcinoma: A prospective phase Ⅱ study from South India. Indian J Cancer, 2017, 54(1): 47-51.
34. Li ZY, Tang L, Zhang LH, et al. Weekly docetaxel and cisplatin plus fluorouracil as a preoperative treatment for gastric cancer patients with synchronous multiple hepatic metastases: a pilot study. Med Oncol, 2010, 27(4): 1314-1318.
35. Chen L, Song MQ, Lin HZ, et al. Chemotherapy and resection for gastric cancer with synchronous liver metastases. World J Gastroenterol, 2013, 19(13): 2097-2103.
36. 朱正纲. 晚期胃癌转化治疗的理念与临床意义. 外科理论与实践, 2017, 22(1): 1-4.
37. Gadde R, Tamariz L, Hanna M, et al. Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis. J Surg Oncol, 2015, 112(1): 38-45.
38. Fujimura T, Nakamura K, Oyama K, et al. Selective lymphadenectomy of para-aortic lymph nodes for advanced gastric cancer. Oncol Rep, 2009, 22(3): 509-514.
39. Yoshikawa T, Sasako M, Yamamoto S, et al. Phase Ⅱ study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg, 2009, 96(9): 1015-1022.
40. Tsuburaya A, Mizusawa J, Tanaka Y, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg, 2014, 101(6): 653-660.
41. Ito S, Sano T, Mizusawa J, et al. A phase II study of preoperative chemotherapy with docetaxel, cisplatin, and S-1 followed by gastrectomy with D2 plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis: JCOG1002. Gastric Cancer, 2017, 20(2): 322-331.
42. Wang Y, Yu YY, Li W, et al. A phase Ⅱ trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis. Cancer Chemother Pharmacol, 2014, 73(6): 1155-1161.
43. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
44. Roviello F, Pedrazzani C, Marrelli D, et al. Super-extended (D3) lymphadenectomy in advanced gastric cancer. Eur J Surg Oncol, 2010, 36(5): 439-446.
45. Yoshida K, Yamaguchi K, Okumura N, et al. Is conversion therapy possible in stage Ⅳ gastric cancer: the proposal of new biological categories of classification. Gastric Cancer, 2016, 19(2): 329-338.
46. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet, 2010, 376(9742): 687-697.

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Research progress on conversion chemotherapy of stage Ⅳ gastric cancer

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