Clinical Pathways for Advance Stage Gastric Cancer: Standardizing Practice to Decrease Variability and Improve Outcomes


Lilly USA, LLC, provided funding for this report. HMP Communications maintained full editorial control.

Acknowledgements: We thank Valerie Lee, MD, (The Sydney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD) and Jeffrey William Clark, MD, (Massachusetts General Hospital, Boston, MA) for contributing their insights and perspectives to this report. Dr. Lee and Dr. Clark have no financial interests to disclose. We also thank Emma Brey Holliday, MD, (The University of Texas MD Anderson Cancer Center, Houston, TX) for reviewing this report.

Key Words


Gastric cancer is the fifth most diagnosed cancer worldwide and the third leading cause of cancer deaths. In the United States and other countries with low rates of gastric cancer, the population is not routinely screened for the disease, so it is diagnosed at later stages and has worse prognosis. For patients with advanced gastric cancer, the median overall survival rate is less than 5 months with best supportive care management.

Palliative therapy with chemotherapy and other agents can improve overall survival and quality of life for patients with advanced or recurrent disease. The 2016 National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Gastric Cancer (Version 3.2016) note that first-line therapy using two chemotherapy agents is preferable for patients with advanced disease, though a combination with three agents is a good option for patients who are medically fit. The choice of a second-line therapy for stage IV or recurrent gastric cancer depends on first line treatment and the patient’s performance status. Data on the cost-effectiveness of these treatments are limited, and there is evidence of high variability in treatment for patients with advanced stage gastric cancer.

Clinical pathways are frequently used to support treatment decision-making for oncology, weighing clinical benefit, toxicity, and cost considerations to arrive at the highest value treatment pathway. Given that gastric cancer does not have a widely accepted standard treatment for either first- or second-line treatment, clinical pathways have the potential to standardize practice, decrease variability, and improve outcomes for this disease.

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