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      Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

      review-article
      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , , 41 , , 42 , , on behalf of The Development Working Groups for the Korean Practice Guidelines for Gastric Cancer 2022 Task Force Team
      Journal of Gastric Cancer
      The Korean Gastric Cancer Association
      Stomach neoplasms, Chemotherapy, Endoscopy, Surgery, Guidelines

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

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          Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade

          The genomes of cancers deficient in mismatch repair contain exceptionally high numbers of somatic mutations. In a proof-of-concept study, we previously showed that colorectal cancers with mismatch repair deficiency were sensitive to immune checkpoint blockade with antibodies to programmed death receptor-1 (PD-1). We have now expanded this study to evaluate the efficacy of PD-1 blockade in patients with advanced mismatch repair-deficient cancers across 12 different tumor types. Objective radiographic responses were observed in 53% of patients, and complete responses were achieved in 21% of patients. Responses were durable, with median progression-free survival and overall survival still not reached. Functional analysis in a responding patient demonstrated rapid in vivo expansion of neoantigen-specific T cell clones that were reactive to mutant neopeptides found in the tumor. These data support the hypothesis that the large proportion of mutant neoantigens in mismatch repair-deficient cancers make them sensitive to immune checkpoint blockade, regardless of the cancers' tissue of origin.
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            Comprehensive molecular characterization of gastric adenocarcinoma

            Gastric cancer is a leading cause of cancer deaths, but analysis of its molecular and clinical characteristics has been complicated by histological and aetiological heterogeneity. Here we describe a comprehensive molecular evaluation of 295 primary gastric adenocarcinomas as part of The Cancer Genome Atlas (TCGA) project. We propose a molecular classification dividing gastric cancer into four subtypes: tumours positive for Epstein–Barr virus, which display recurrent PIK3CA mutations, extreme DNA hypermethylation, and amplification of JAK2, CD274 (also known as PD-L1) and PDCD1LG2 (also knownasPD-L2); microsatellite unstable tumours, which show elevated mutation rates, including mutations of genes encoding targetable oncogenic signalling proteins; genomically stable tumours, which are enriched for the diffuse histological variant and mutations of RHOA or fusions involving RHO-family GTPase-activating proteins; and tumours with chromosomal instability, which show marked aneuploidy and focal amplification of receptor tyrosine kinases. Identification of these subtypes provides a roadmap for patient stratification and trials of targeted therapies.
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              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.

              Trastuzumab, a monoclonal antibody against human epidermal growth factor receptor 2 (HER2; also known as ERBB2), was investigated in combination with chemotherapy for first-line treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer. ToGA (Trastuzumab for Gastric Cancer) was an open-label, international, phase 3, randomised controlled trial undertaken in 122 centres in 24 countries. Patients with gastric or gastro-oesophageal junction cancer were eligible for inclusion if their tumours showed overexpression of HER2 protein by immunohistochemistry or gene amplification by fluorescence in-situ hybridisation. Participants were randomly assigned in a 1:1 ratio to receive a chemotherapy regimen consisting of capecitabine plus cisplatin or fluorouracil plus cisplatin given every 3 weeks for six cycles or chemotherapy in combination with intravenous trastuzumab. Allocation was by block randomisation stratified by Eastern Cooperative Oncology Group performance status, chemotherapy regimen, extent of disease, primary cancer site, and measurability of disease, implemented with a central interactive voice recognition system. The primary endpoint was overall survival in all randomised patients who received study medication at least once. This trial is registered with ClinicalTrials.gov, number NCT01041404. 594 patients were randomly assigned to study treatment (trastuzumab plus chemotherapy, n=298; chemotherapy alone, n=296), of whom 584 were included in the primary analysis (n=294; n=290). Median follow-up was 18.6 months (IQR 11-25) in the trastuzumab plus chemotherapy group and 17.1 months (9-25) in the chemotherapy alone group. Median overall survival was 13.8 months (95% CI 12-16) in those assigned to trastuzumab plus chemotherapy compared with 11.1 months (10-13) in those assigned to chemotherapy alone (hazard ratio 0.74; 95% CI 0.60-0.91; p=0.0046). The most common adverse events in both groups were nausea (trastuzumab plus chemotherapy, 197 [67%] vs chemotherapy alone, 184 [63%]), vomiting (147 [50%] vs 134 [46%]), and neutropenia (157 [53%] vs 165 [57%]). Rates of overall grade 3 or 4 adverse events (201 [68%] vs 198 [68%]) and cardiac adverse events (17 [6%] vs 18 [6%]) did not differ between groups. Trastuzumab in combination with chemotherapy can be considered as a new standard option for patients with HER2-positive advanced gastric or gastro-oesophageal junction cancer. F Hoffmann-La Roche. Copyright 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                J Gastric Cancer
                J Gastric Cancer
                JGC
                Journal of Gastric Cancer
                The Korean Gastric Cancer Association
                2093-582X
                2093-5641
                January 2023
                31 January 2023
                : 23
                : 1
                : 3-106
                Affiliations
                [1 ]Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
                [2 ]Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [3 ]Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea.
                [4 ]National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea.
                [5 ]Department of Pathology, Korea University Guro Hospital, Seoul, Korea.
                [6 ]Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
                [7 ]Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
                [8 ]Department of Medicine, Samsung Medical Center, Seoul, Korea.
                [9 ]Department of Surgery, Pusan National University Hospital, Pusan, Korea.
                [10 ]Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea.
                [11 ]Department of Internal Medicine, Ewha Woman’s University College of Medicine, Seoul, Korea.
                [12 ]Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.
                [13 ]Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [14 ]Department of Nuclear Medicine, Severance Hospital, Seoul, Korea.
                [15 ]Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
                [16 ]Department of Surgery, Soonchunhyang University, Cheonan, Korea.
                [17 ]Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
                [18 ]Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
                [19 ]Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea.
                [20 ]Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                [21 ]Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
                [22 ]Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
                [23 ]Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea.
                [24 ]Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
                [25 ]Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
                [26 ]Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
                [27 ]Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
                [28 ]Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
                [29 ]Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
                [30 ]Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
                [31 ]Department of Radiology, National Cancer Center, Goyang, Korea.
                [32 ]Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [33 ]Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
                [34 ]Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea.
                [35 ]Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
                [36 ]Department of Surgery, Dankook University Hospital, Cheonan, Korea.
                [37 ]Department of Surgery, Severance Hospital, Seoul, Korea.
                [38 ]Department of Pathology, Seoul National University Hospital, Seoul, Korea.
                [39 ]Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
                [40 ]Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
                [41 ]Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
                [42 ]Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
                Author notes
                Correspondence to Hye Sook Han. Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea. hyesukhan@ 123456chungbuk.ac.kr
                Correspondence to Su Youn Nam. Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea. nam20131114@ 123456gmail.com
                Correspondence to Seong-Ho Kong. Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. seongho.kong@ 123456snu.ac.kr

                *Tae-Han Kim, In-Ho Kim, and Seung Joo Kang contributed equally to this work.

                Hye Sook Han, Su Youn Nam, and Seong-Ho Kong contributed equally as Co-corresponding authors.

                Author information
                https://orcid.org/0000-0002-5012-7208
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                https://orcid.org/0000-0003-2360-5160
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                Article
                10.5230/jgc.2023.23.e11
                9911619
                36750993
                2914cdca-5e61-4a38-968c-885d27baaae9
                Copyright © 2023. Korean Gastric Cancer Association

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 January 2023
                : 22 January 2023
                : 25 January 2023
                Funding
                Funded by: The Korean Gastric Cancer Association
                Funded by: Ministry of Health and Welfare, CrossRef https://doi.org/10.13039/501100003625;
                Award ID: NCC-2112570-1
                Award ID: NCC-2112570-2
                Award ID: NCC-2112570-3
                Categories
                Special Article

                Oncology & Radiotherapy
                stomach neoplasms,chemotherapy,endoscopy,surgery,guidelines
                Oncology & Radiotherapy
                stomach neoplasms, chemotherapy, endoscopy, surgery, guidelines

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