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Treatment of Stage IV-Metastatic Gastric Cancer

Patients with stage IV gastric cancer have cancer that has spread to distant sites. Optimal treatment for some patients with stage IV gastric cancer often requires more than one therapeutic approach. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving medical oncologists, radiation oncologists, surgeons, gastroenterologists, nutritionists, and access to clinical trials.


For patients with Stage IV gastric cancer, surgery may be performed in order to reduce bleeding or to keep the cancer from obstructing the intestines or stomach.1


Chemotherapy can relieve symptoms and extend survival for some patients with advanced gastric cancer. Several chemotherapy regimens are available, and the choice of which to use depends in part on the patient’s health. Chemotherapy may be used in combination with other treatments such as precision cancer medicine, radiation therapy, and/or surgery.2,3,4

Precision Cancer Medicines

All patients with advanced gastric cancer should undergo genomic biomarker testing for HER2, PD-1 and other targets in order to determine if they can benefit from treatment with a precision cancer medicine.

Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be used to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack gastric cancer cells with specific abnormalities, leaving normal cells largely unharmed.

Roughly 20% of patients with gastric cancer have cancer that over expresses (makes too much of) this protein; these cancers are referred to as HER2-positive. For patients with HER2-positive, metastatic gastric cancer, treatment with Herceptin can improve overall survival.3,4,5

Radiation Therapy

Radiation therapy involves the use of a particular type of energy, known as ionizing radiation, to kill cancer cells. Radiation can play a role in managing the symptoms of advanced gastric cancer and can also help to control problems such as bleeding or blockages.

Next: Precision Cancer Medicines



1 Huscher CG, Mingoli A, Sgarzini G et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Annals of Surgery. 2005;241:232-7.

2 Yung-Jue Bang, MD, PhD et al. online in the Journal of Clinical Oncology.

3 Bang Y-J, 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; 376:687-697.

4 Abstract LBA28_PR ‘KEYNOTE-059 Update: Efficacy and Safety of Pembrolizumab Alone or in Combination With Chemotherapy in Patients With Advanced Gastric or Gastroesophageal (G/GEJ) cancer.


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