The Impact of Neoadjuvant Therapy in Treating Stomach Cancer

Gastric cancer, or stomach cancer, is a challenging illness on a global scale. It is the leading factor of cancerous deaths, especially in regions with high incidences of cancer, e.g., Eastern Asia and Eastern European countries.

According to a study, gastric cancer is the fifth most common cancer and the third most prevalent cancer death globally in 2020, with 1.1 million new cases and 770,000 cancer deaths reported. Estimates indicate a 62% increase in numbers by 2040 (and a total of 1.77 million cases).

Recent developments in treatment options for stomach cancer have provided hope to patients, where neoadjuvant therapy has become a pillar of the fight against this disease. Neoadjuvant therapy is the application of treatments such as chemotherapy or radiation before surgery during a treatment course to attenuate tumour size and enhance outcomes.

This blog examines the impact of neoadjuvant therapy on gastric cancer, including its advantages, adverse reactions, and implications in integrated therapeutic approaches.

Understanding Neoadjuvant Therapy for Stomach Cancer

Neoadjuvant therapy is a therapy regimen in which therapeutic compounds are included in treatment prior to surgery. For gastric cancer, neoadjuvant therapy is valuable for patients with locoregionally advanced disease (i.e., disease in which the tumour has outgrown the gastric wall but has not disseminated to other organs of the body). 

The primary objectives of neoadjuvant therapy for stomach cancer are:

• Reducing Tumor Size: The reduction in tumour size is important to facilitate and improve surgical resection.
• Eliminating Micrometastases: Targeting metastatic cancer cells that may have spread but are not yet visible.
• Improving Survival Rates: The long-term outcomes are enhanced by reducing the likelihood of recurrence.

Neoadjuvant chemotherapy is the most used treatment option for stomach cancer, usually with the addition of radiation to the treatment in some cases. The regimen choice depends on the disease stage, the patient's overall health, and tumour-specific characteristics.

Stomach Cancer Staging and Treatment Options

Staging is one of the key considerations to determine the optimal treatment for stomach cancer. The steps are from I (local lesion) to IV (metastatic cancer). For early-stage tumours, surgery or endoscopic resection may be successful. However, advanced stages often require a multimodal approach:

• Stage I-II: Neoadjuvant therapy plus surgery, adjuvant therapy (as applicable).

• Stage III: Comprehensive neoadjuvant chemotherapy, surgery, and post-operative treatments.

• Stage IV: Palliative chemotherapy, targeted therapy, or immunotherapy to manage symptoms and prolong life.

The portability of neoadjuvant therapy in treatment strategies has transformed the prognosis for patients with stages II and III gastric cancer, offering them a better chance of curative treatment.

Gastric Cancer Prognosis After Neoadjuvant Therapy

A number of studies have shown that the outcome of gastric cancer is greatly affected by neoadjuvant therapy. Treatment patients may, at times, show improved survivability as compared to patients treated with surgery alone. The key benefits include:

• Downstaging Tumors: Neoadjuvant therapy has the ability to downstage the tumour and improve complete surgical removal.

• Pathological Response: On the other side, a favourable pathological response, in which a large part of the tumour is also destroyed, is connected to improved survival.

• Enhanced Operability: This therapy, by reducing the size of tumors, allows minimally invasive surgical interventions, thereby decreasing complications.

• Improved Lymph Node Clearance: Neoadjuvant therapy has the potential to reduce the number of cancerous lymph nodes, which is crucial for staging and prognosis.

Meta-analysis of clinical trials showed that patients treated with neoadjuvant chemotherapy experienced 10-15% improvement in 5-year survival rates compared with surgery-first treatment.

Side Effects of Neoadjuvant Therapy

Despite its great benefits, it is not without the side effects of neoadjuvant therapy. Patients can have adverse drug reactions; factors include drug prescriptions, drug doses, and patient tolerance. Common side effects include:

• Nausea and Vomiting: These side effects are common with chemotherapy.
• Fatigue: This results from the body's response to treatment.
• Hair Loss: A visible effect of chemotherapy could be the hair loss.
• Bone Marrow Suppression: This leads to anaemia, infections, and increased bleeding risk.
• Gastrointestinal Symptoms: The possible symptoms are diarrhoea or constipation.

Side effects management is a multidisciplinary problem that requires oncologists, dietitians, and allied, supportive care providers.

Advances in Neoadjuvant Therapy

Recent advances in neoadjuvant therapy have been directed at patient-specific treatments. Innovations include:

• Targeted Therapy: Using specific cytotoxic agents, e.g., HER2 inhibitors, for HER2-positive gastric malignancies.

• Immunotherapy: Immunisation using the immune system against cancer, especially for tumours exhibiting high microsatellite instability (MSI).

• Precision Medicine: Genetic profiling of tumours in search of mutations and treatment selection.

These advances are leading towards more effective and less toxic neoadjuvant agents.

Cost Considerations and Access to Care

• The cost of neoadjuvant therapy for gastric cancer can differ substantially based on the regimens, length of therapy, and location. 
• For many patients, financial barriers remain a significant challenge. Government programs, insurance, and financial aid programs can assist in reducing the pressure.

• Patients should take care of the cost along with the quality of the healthcare provider and the quality of the clinic. 
• Use of highly experienced oncologists, modern technology equipment, and multidisciplinary care teams can have a significant impact on the result.

If you are looking for affordable gastrointestinal cancer cost in India, it is always recommended to do a comparative cost evaluation considering the hospital choice, location, and the selected doctor.

Finding the Best Doctors and Hospitals in India to Treat 

The selection of the best oncologist in India for gastric cancer treatment plays an important role in the outcome. Here are some tips for selecting the best options:

• Expertise in Gastric Cancer: Oncologists and surgeons who have a documented track record of treatment success rate.
• Advanced Cancer Centers: Top-notch hospitals that provide multidisciplinary care, covering surgical oncology and medical oncology specialties and supportive services.
• Clinical Trials: Hospitals conducting clinical trials have access to the most recent treatments.
• Patient Reviews and Outcomes: Research patient testimonials and survival statistics.

Another key decision is the hospital site; medical development, diagnostic equipment, medical institution, hospital accreditation, and online reviews may be used as decision aids to select the best oncology and oncosurgery hospital for stomach cancer therapy.

Looking Towards the Betterment in Neoadjuvant Therapy: Promising Future Advancement

Neoadjuvant therapy has transformed the therapeutic landscape of gastric cancer, offering hope to patients with advanced disease. This approach has been incorporated in multimodal treatment strategies, tumour segmentation, reducing the size of the tumours, the benefits of surgery, and survival with increasing efficiency. Even under the difficult circumstances of disease, a new generation of gastric cancer patients is searching for targeted therapy and precision medicine.

For those battling stomach cancer, understanding the role of neoadjuvant therapy and accessing the best medical care can make a significant difference. Being aware and involved guides patients and families to have this experience with hope and confidence.