Abstract
Metastatic gastric carcinoma has aggressive behaviour with overall survival less than one year. In first-line treatment, platinum- and fluoropyrimidine-based combinations are used.
In a subset of patients with HER2-positive tumours, addition of trastuzumab to standard therapy led to prolonged overall survival. In second-line therapy, robust data support the use of ramucirumab, especially in combination with paclitaxel, other options include taxanes or irinotecan.
In third-line therapy, novel chemotherapy drug trifluridin/tipiracil or immunotherapy can be used. The survival benefit has been shown in trials with nivolumab and pembrolizumab.