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Russian consensus on prevention, diagnosis and treatment of gastric cancer. Systemic therapy issues

https://doi.org/10.18027/2224-5057-2025-036

Abstract

The Russian consensus on prevention, diagnostic and treatment of gastric cancer was prepared on the initiative of the Moscow clinical scientific center named after A. S. Loginov on the Delphi method. Its aim was to clarify and consolidate the opinions of specialists on the most relevant issues of prevention, diagnosis and treatment of gastric cancer. An interdisciplinary approach was provided by the participation of leading gastroenterologists, oncologists and surgeons.

About the Authors

E. V. Artamonova
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

Elena Vladimirovna Artamonova

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



N. S. Besova
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
Russian Federation

Nataliya Sergeevna Besova

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



L. V. Bolotina
P. A. Hertsen Moscow Oncology Research Institute — branch of the National Medical Research Radiological Center, Ministry of Health of Russia
Russian Federation

Larisa Vladimirovna Bolotina

3 2nd Botkinskiy proezd, Moscow 125284


Competing Interests:

The authors declare that there are no possible conflicts of interest



L. Yu. Vladimirova
National Medical Research Centre for Oncology
Russian Federation

Lyubov Yurevna Vladimirova

63 14 liniya St., Rostov-on-Don 344037


Competing Interests:

The authors declare that there are no possible conflicts of interest



L. G. Zhukova
A. S. Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Russian Federation

Lyudmila Grigorevna Zhukova

Build. 1, 1 Novogireevskaya St., Moscow 111123


Competing Interests:

The authors declare that there are no possible conflicts of interest



E. O. Ignatova
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
Russian Federation

Ekaterina Olegovna Ignatova

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



V. M. Moiseenko
N. P. Napalkov Saint Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncological)
Russian Federation

Vladimir Mikhailovich Moiseenko

lit. A, 68A Leningradskaya St., Pesochnyy, Saint Petersburg 197758


Competing Interests:

The authors declare that there are no possible conflicts of interest



I. A. Pokataev
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
Russian Federation

Ilya Anatolevich Pokataev

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



N. E. Semenov
A. S. Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department
Russian Federation

Nikolai Evgenevich Semenov

Build. 1, 1 Novogireevskaya St., Moscow 111123


Competing Interests:

The authors declare that there are no possible conflicts of interest



D. L. Stroyakovskii
Moscow City Oncology Hospital No. 62, Moscow Healthcare Department
Russian Federation

Daniil Lvovich Stroyakovskii

27 Istra, Moscow Region 143515


Competing Interests:

The authors declare that there are no possible conflicts of interest



A. A. Tryakin
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
Russian Federation

Aleksei Aleksandrovich Tryakin

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



S. A. Tyulyandin
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
Russian Federation

Sergei Alekseevich Tyulyandin

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



A. A. Fedenko
P. A. Hertsen Moscow Oncology Research Institute — branch of the National Medical Research Radiological Center, Ministry of Health of Russia
Russian Federation

Aleksandr Aleksandrovich Fedenko

3 2nd Botkinskiy proezd, Moscow 125284


Competing Interests:

The authors declare that there are no possible conflicts of interest



M. Yu. Fedyanin
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
Russian Federation

Mikhail Yurevich Fedyanin

23 Kashirskoe Shosse, Moscow 115478


Competing Interests:

The authors declare that there are no possible conflicts of interest



L. N. Shevkunov
N. N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

Lev Nikolaevich Shevkunov

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758


Competing Interests:

The authors declare that there are no possible conflicts of interest



References

1. Smyth E.C., Verheij M., Allum W., et al. ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016;27(suppl 5):v38-v49. https://doi.org/10.1093/annonc/mdw350

2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24(1):1–21. https://doi.org/10.1007/s10120-020-01041-y

3. NCCN Clinical Practice Guideline for Gastric Cancer version 3.2020. https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf

4. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach. J Gastric Cancer 2019;19(1):1–48. doi: 10.5230/jgc.2019.19.e8. Epub 2019 Mar 19. Erratum in: J Gastric Cancer 2019 Sep;19(3):372–373

5. Polom K., Marano L., Marrelli D., et al. Meta-analysis of microsatellite instability in relation to clinicopathological characteristics and overall survival in gastric cancer. Br J Surg 2018;105(3):159–167. https://doi.org/10.1002/bjs.10663

6. Kim S.Y., Choi Y.Y., An J.Y., et al. The benefit of microsatellite instability is attenuated by chemotherapy in stage II and stage III gastric cancer: Results from a large cohort with subgroup analyses. Int J Cancer 2015;137(4):819–25. https://doi.org/10.1002/ijc.29449

7. Pietrantonio F., Miceli R., Raimondi A., et al. Individual patient data meta-analysis of the value of microsatellite instability as a biomarker in gastric cancer. J Clin Oncol 2019;37(35):3392–3400. https://doi.org/10.1200/JCO.19.01124

8. André T., Tougeron D., Piessen G., et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: the GERCOR NEONIPIGA phase II study. J Clin Oncol 2023;41(2):255–265. https://doi.org/10.1200/JCO.22.00686

9. Pietrantonio F., Raimondi A., Lonardi S., et al. INFINITY: A multicentre, single-arm, multi-cohort, phase II trial of tremelimumab and durvalumab as neoadjuvant treatment of patients with microsatellite instability-high (MSI) resectable gastric or gastroesophageal junction adenocarcinoma (GAC/GEJAC). J Clin Oncol 2023;41(4): suppl 358. https://doi.org/10.1200/JCO.2023.41.4_suppl.358

10. Lorenzen S., Götze T.O., Thuss-Patience P., et al. Perioperative atezolizumab plus fluorouracil, leucovorin, oxaliplatin, and docetaxel for resectable esophagogastric cancer: interim results from the randomized, multicenter, phase II/III DANTE/IKF-s633 trial. J Clin Oncol 2024;42(4):410–420. https://doi.org/10.1200/JCO.23.00975

11. Sun H., Moiseyenko V., Chubenko V., et al. Neoadjuvant chemo-immunotherapy in mismatch repair deficient (dMMR)/ microsatellite instability (MSI) gastric carcinoma (GC): A multicenter retrospective study. Ann Oncol 2024;35(suppl_2):S180-S181. https://doi.org/10.1016/j.annonc.2024.05.362

12. Van Cutsem E., Moiseyenko V.M., 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):4991–7. https://doi.org/10.1200/JCO.2006.06.8429

13. Wang J., Xu R., Li J., et al. Randomized multicenter phase III study of a modified docetaxel and cisplatin plus fluorouracil regimen compared with cisplatin and fluorouracil as first-line therapy for advanced or locally recurrent gastric cancer. Gastric Cancer 2016;19(1):234–44. https://doi.org/10.1007/s10120-015-0457-4

14. Yamada Y., Boku N., Mizusawa J., et al. Docetaxel plus cisplatin and S-1 versus cisplatin and S-1 in patients with advanced gastric cancer (JCOG1013): an open-label, phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol 2019;4(7):501–510. https://doi.org/10.1016/S2468-1253(19)30083-4

15. Guo X., Zhao F., Ma X., et al. A comparison between triplet and doublet chemotherapy in improving the survival of patients with advanced gastric cancer: a systematic review and meta-analysis. BMC Cancer 2019;19(1):1125. https://doi.org/10.1186/s12885-019-6294-9

16. Zaanan A., Bouche O., de la Fouchardiere C., et al. LBA77 5-fluorouracil and oxaliplatin with or without docetaxel in the first-line treatment of HER2 negative locally advanced (LA) unresectable or metastatic gastric or gastro-esophageal junction (GEJ) adenocarcinoma (GASTFOX-PRODIGE 51): A randomized phase III trial sponsored by the FFCD. Ann Oncol 2023;34(suppl_2):S1254-S1335. https://doi.org/10.1016/S0923-7534(23)04149-2

17. Ramaswamy A., Bhargava P., Dubashi B., et al. A two-arm randomized open-label prospective design superiority phase III clinical trial to compare the efficacy of docetaxel-oxaliplatin-capecitabine/5 fluorouracil (DOC/F) followed by docetaxel versus CAPOX/mFOLFOX-7 in advanced gastric cancers (DOC-GC study). J Clin Oncol 2024;42(3_suppl): LBA248-LBA248. https://doi.org/10.1200/JCO.2024.42.3_suppl.LBA248

18. Messager M., Lefevre J.H., Pichot-Delahaye V., et al. The impact of perioperative chemotherapy on survival in patients with gastric signet ring cell adenocarcinoma: a multicenter comparative study. Ann Surg 2011;254(5):684–93; https://doi.org/10.1097/SLA.0b013e3182352647

19. Sasako M., Sakuramoto S., Katai H., et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011;29(33):4387–93. https://doi.org/10.1200/JCO.2011.36.5908

20. Noh S.H., Park S.R., Yang H.K., et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol 2014;15(12):1389–96. https://doi.org/10.1016/S1470-2045(14)70473-5

21. Kozak K.R., Moody J.S. The survival impact of the intergroup 0116 trial on patients with gastric cancer. Int J Radiat Oncol Biol Phys 2008;72(2):517–21. https://doi.org/10.1016/j.ijrobp.2007.12.029

22. Ychou M., Boige V., Pignon J.P., et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011;29(13):1715–21. https://doi.org/10.1200/JCO.2010.33.0597

23. Cunningham D., Allum W.H., Stenning S.P., et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355(1):11–20. https://doi.org/10.1056/NEJMoa055531

24. Al-Batran S.E., Homann N., Pauligk C., et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019;393(10184):1948–1957. https://doi.org/10.1016/S0140-6736(18)32557-1

25. Lutz M.P., Zalcberg J.R., Ducreux M., et al. The 4th St. Gallen EORTC Gastrointestinal Cancer Conference: Controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma. Eur J Cancer 2019;112:1–8. https://doi.org/10.1016/j.ejca.2019.01.106

26. Sasako M., Sakuramoto S., Katai H., et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011;29(33):4387–93. https://doi.org/10.1200/JCO.2011.36.5908

27. Yoshida K., Kodera Y., Kochi M., et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol 2019;37(15):1296–1304. https://doi.org/10.1200/JCO.18.01138

28. Park S.H., Zang D.Y., Han B., et al. ARTIST 2: Interim results of a phase III trial involving adjuvant chemotherapy and/ or chemoradiotherapy after D2-gastrectomy in stage II/III gastric cancer (GC). J Clin Oncol 2019;37(15_suppl):4001. https://doi.org/10.1200/jco.2019.37.15_suppl.4001

29. Cunningham D., Allum W.H., Stenning S.P., et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355(1):11–20. https://doi.org/10.1056/NEJMoa055531

30. Allum W.H., Stenning S.P., Bancewicz J., et al. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 2009;27(30):5062–5067. https://doi.org/10.1200/JCO.2009.22.2083

31. Al-Batran S. E, Homann N, Pauligk C., et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019;393(10184):1948–1957. https://doi.org/10.1016/S0140-6736(18)32557-1

32. Van den Ende T., Veer E.T., Machiels M., et al. The efficacy and safety of (Neo)adjuvant therapy for gastric cancer: a network meta-analysis. Cancers (Basel) 2019;11(1):80. https://doi.org/10.3390/cancers11010080

33. Trumper M., Ross P.J., Cunningham D., et al. Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophago-gastric cancer: A pooled analysis of three clinical trials. Eur J Cancer 2006;42(7):827–34. https://doi.org/10.1016/j.ejca.2005.08.044

34. Jatoi A., Foster N.R., Egner J.R., et al. Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: a pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials. Int J Oncol 2010;36(3):601–6. https://doi.org/10.3892/ijo_00000535

35. Hall P.S., Lord S.R., Collinson M., et al. A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO). Br J Cancer 2017;116(4):472–478. https://doi.org/10.1038/bjc.2016.442

36. Hwang I.G., Ji J.H., Kang J.H., et al. A multi-center, open-label, randomized phase III trial of first-line chemotherapy with capecitabine monotherapy versus capecitabine plus oxaliplatin in elderly patients with advanced gastric cancer. J Geriatr Oncol 2017;8(3):170–175. https://doi.org/10.1016/j.jgo.2017.01.002

37. Hall P.S., Swinson D., Cairns D.A., et al. Efficacy of reduced-intensity chemotherapy with oxaliplatin and capecitabine on quality of life and cancer control among older and frail patients with advanced gastroesophageal cancer: the GO2 phase 3 randomized clinical trial. JAMA Oncol 2021;7(6):869–877. https://doi.org/10.1001/jamaoncol.2021.0848

38. Thuss-Patience P.C., Kretzschmar A., Bichev D., et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer--a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer 2011;47(15):2306–14. https://doi.org/10.1016/j.ejca.2011.06.002

39. Ford H.E., Marshall A., Bridgewater J.A., et al. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. Lancet Oncol 2014;15(1):78–86. https://doi.org/10.1016/S1470-2045(13)70549-7

40. Hironaka S., Ueda S., Yasui H., et al. Randomized, open-label, phase III study comparing irinotecan with paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior combination chemotherapy using fluoropyrimidine plus platinum: WJOG 4007 trial. J Clin Oncol 2013;31(35):4438–44. https://doi.org/10.1200/JCO.2012.48.5805

41. Wilke H., Muro K., Van Cutsem E., et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastrooesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol 2014;15(11):1224–1235. https://doi.org/10.1016/S1470-2045(14)70420-6

42. Kaya A.O., Coskun U., Gumus M., et al. The efficacy and toxicity of irinotecan with leucovorin and bolus and continuous infusional 5-fluorouracil (FOLFIRI) as salvage therapy for patients with advanced gastric cancer previously treated with platinum and taxane-based chemotherapy regimens. J Chemother 2012;24(4):217–20. https://doi.org/10.1179/1973947812Y.0000000020

43. Maugeri-Saccà M., Pizzuti L., Sergi D., et al. FOLFIRI as a second-line therapy in patients with docetaxel-pretreated gastric cancer: a historical cohort. J Exp Clin Cancer Res 2013;32(1):67. https://doi.org/10.1186/1756-9966-32-67

44. Sendur M.A., Ozdemir N., Özatlı T., et al. Comparison the efficacy of second-line modified EOX (epirubicin, oxaliplatin, and capecitabine) and irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) regimens in metastatic gastric cancer patients that progressed on first-line modified docetaxel and cisplatin plus fluorouracil (DCF) regimen. Med Oncol 2014;31(9):153. https://doi.org/10.1007/s12032-014-0153-y

45. Jung J.Y., Ryu M.H., Ryoo B.Y., et al. Second-line irinotecan, leucovorin, and 5-fluorouracil for gastric cancer patients after failed docetaxel and S-1. Gastroenterol Res Pract 2016;2016:6857625. https://doi.org/10.1155/2016/6857625

46. Klempner S.J., Maron S.B., Chase L., et al. Initial report of second-line FOLFIRI in combination with ramucirumab in advanced gastroesophageal adenocarcinomas: a multi-institutional retrospective analysis. Oncologist 2019;24(4):475–482. https://doi.org/10.1634/theoncologist.2018-0602

47. Besova N.S., Titova T.A., Stroyakovsky D.L., et al. Results of the use of ramucirumab in combination with irinotecan and fluoropyrimidines in the second-line chemotherapy for disseminated gastric cancer. Meditsinsky Sovet 2019;10:100–109 (In Russ.). https://doi.org/10.21518/2079-701X-2019-10-100-109

48. Lorenzen S., Thuss-Patiens P., Pauligk C., et al. FOLFIRI plus ramucirumab versus paclitaxel plus ramucirumab for patients with advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction as second-line therapy: Interim safety and efficacy results from the phase II RAMIRIS Study (AIO-STO-0415) of the German Gastric Group at AIO. Journal of Clinical Oncology 38(15_suppl):4514–4514. https://doi.org/10.1200/JCO.2020.38.15suppl.4514

49. Sym S.J., Hong J., Park J., et al. A randomized phase II study of biweekly irinotecan monotherapy or a combination of irinotecan plus 5-fluorouracil/leucovorin (mFOLFIRI) in patients with metastatic gastric adenocarcinoma refractory to or progressive after first-line chemotherapy. Cancer Chemother Pharmacol 2013;71(2):481–8. https://doi.org/10.1007/s00280-012-2027-3

50. Tanabe K., Fujii M., Nishikawa K., et al. Phase II/III study of second-line chemotherapy comparing irinotecan-alone with S-1 plus irinotecan in advanced gastric cancer refractory to first-line treatment with S-1 (JACCRO GC-05). Ann Oncol 2015;26(9):1916–1922. https://doi.org/10.1093/annonc/mdv265

51. Shitara K., Özgüroğlu M., Bang Y.J., et al. Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061): a randomised, open-label, controlled, phase 3 trial. Lancet 2018;392(10142):123–133. https://doi.org/10.1016/S0140-6736(18)31257-1

52. Chao J., Fuchs C.S., Shitara K., et al. Assessment of pembrolizumab therapy for the treatment of microsatellite instability-high gastric or gastroesophageal junction cancer among patients in the KEYNOTE-059, KEYNOTE-061, and KEYNOTE-062 clinical trials. JAMA Oncol 2021;7(6):895–902. https://doi.org/10.1001/jamaoncol.2021.0275.


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For citations:


Artamonova E.V., Besova N.S., Bolotina L.V., Vladimirova L.Yu., Zhukova L.G., Ignatova E.O., Moiseenko V.M., Pokataev I.A., Semenov N.E., Stroyakovskii D.L., Tryakin A.A., Tyulyandin S.A., Fedenko A.A., Fedyanin M.Yu., Shevkunov L.N. Russian consensus on prevention, diagnosis and treatment of gastric cancer. Systemic therapy issues. Malignant tumours. 2025;15(1):76–85. (In Russ.) https://doi.org/10.18027/2224-5057-2025-036

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ISSN 2224-5057 (Print)
ISSN 2587-6813 (Online)