The role of chemotherapy in the current treatment of gastric cancer.

Metaanalyses of adjuvant systemic chemotherapy in gastric cancer have shown at best marginal benefits, although a recent trial of postoperative chemoradiotherapy has demonstrated significantly increased overall survival. Neoadjuvant chemotherapy and chemoradiotherapy are also feasible and are the subject of several ongoing studies. This setting may provide valuable evidence of the activity of new agents and the chemosensitivity of specific tumors. In metastatic disease, chemotherapy confers benefit when compared with best supportive care alone. No particular regimen has been shown to be superior to others in this context, and there is a pressing need for the evaluation of newer agents such as the oral fluoropyrimidines, taxanes, irinotecan, and oxaliplatin.