Gastric Cancer, Version 2.2013

The NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer provide evidenceand consensus-based recommendations for a multidisciplinary approach for the management of patients with gastric cancer. For patients with resectable locoregional cancer, the guidelines recommend gastrectomy with a D1+ or a modified D2 lymph node dissection (performed by experienced surgeons in highvolume centers). Postoperative chemoradiation is the preferred option after complete gastric resection for patients with T3–T4 tumors and node-positive T1–T2 tumors. Postoperative chemotherapy is included as an option after a modified D2 lymph node dissection for this group of patients. Trastuzumab with chemotherapy is recommended as first-line therapy for patients with HER2-positive advanced or metastatic cancer, confirmed by immunohistochemistry and, if needed, by fluorescence in situ hybridization for IHC 2+. (JNCCN 2013;11:531–546) Gastric Cancer, Version 2.2013 © JNCCN—Journal of the National Comprehensive Cancer Network | Volume 11 Number 5 | May 2013 532 NCCN Guidelines Insights C E NCCN: Continuing Education Accreditation Statement This activity has been designated to meet the educational needs of physicians, nurses, and pharmacists involved in the management of patients with cancer. There is no fee for this article. The National Comprehensive Cancer Network (NCCN) is accredited by the ACCME to provide continuing medical education for physicians. NCCN designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NCCN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center`s Commission on Accreditation. This activity is approved for 1.0 contact hour. Approval as a provider refers to recognition of educational activities only; accredited status does not imply endorsement by NCCN or ANCC of any commercial products discussed/displayed in conjunction with the educational activity. Kristina M. Gregory, RN, MSN, OCN, is our nurse planner for this educational activity. National Comprehensive Cancer Network is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NCCN designates this continuing education activity for 1.0 contact hour(s) (0.1 CEUs) of continuing education credit in states that recognize ACPE accredited providers. This is a knowledgebased activity. UAN: 0836-0000-13-007-H01-P All clinicians completing this activity will be issued a certificate of participation. To participate in this journal CE activity: 1) review the learning objectives and author disclosures; 2) study the education content; 3) take the posttest with a 70% minimum passing score and complete the evaluation at http://education.nccn.org/node/19849; and 4) view/print certificate. Release date: May 13, 2013; Expiration date: May 13, 2014 Learning Objectives: Upon completion of this activity, participants will be able to: • Describe the postoperative treatment options for patients with resectable gastric cancer. • Discuss the role of HER-2 testing and trastuzumab for patients with metastatic cancer. EDITOR: Kerrin M. Green, MA, Assistant Managing Editor, JNCCN— Journal of the National Comprehensive Cancer Network, has disclosed that she has no relevant financial relationships. CE AUTHORS: Nicole B. Harrold, BS, Manager, Continuing Education and Grants, has disclosed that she has no relevant financial relationships. Kristina M. Gregory, RN, MSN, OCN, Vice President, Clinical Information Operations, has disclosed that she has no relevant financial relationships. James Prazak, RPh, Assistant Director, Continuing Education and Grants, has disclosed the following relationships with commercial interests: Bristol-Myers Squibb Company: Pension; Pfizer, Inc: Stockholder; United Healthcare Group: Stockholder; Johnson & Johnson: Stockholder. Hema Sundar, PhD, Oncology Scientist/Senior Medical Writer, has disclosed that she has no relevant financial relationships. Disclosure of Affiliations and Significant Relationships The following authors have no relevant financial interests to disclose: Dr. Bentrem, Dr. Besh, Dr. Das, Dr. Fakih, Dr. Gerdes, Dr. Glasgow, Dr. Hayman, Dr. Hofstetter, Dr. Ilson, Dr. Keswani, Dr. Kleinberg, Dr. Meredith, Dr. Mulcahy, Dr. Orringer, Dr. Posey, Dr. Scott, Dr. Strong, Dr. Varghese, Dr. Warren, Dr. Washington, Dr. Willett, and Dr. Wright. The following authors have disclosed that they have financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products or devices discussed in this report or their competitors: Dr. Ajani: Research support from Bayer HealthCare; ImClone Systems Incorporated; Ascenta; Genta; sanofi-aventis; and Taiho Pharmaceuticals Co., Ltd. Speaker bureau member for Bristol-Myers Squibb Company and sanofi-aventis U.S. Dr. D’Amico: Consultant for Scanlan. Dr. Denlinger: PI for AstraZeneca Pharmaceuticals LP; MedImmune Inc.; and Merrimack Pharmaceuticals. Dr. Fuchs: PI for Amgen Inc. and ImClone Systems Incorporated. Advisory board member for Amgen Inc.; Metamark Genetics; Pfizer Inc.; and sanofi-aventis U.S. Consultant for Bristol-Myers Squibb Company; Genentech, Inc.; Genomic Health, Inc.; ImClone Systems Incorporated; Infinity Pharmaceuticals; Momenta Pharmaceuticals; and Roche Laboratories, Inc. Dr. Korn: Advisory board member for Celgene Corporation. Dr. Lockhart: PI for Amgen Inc.; Bayer HealthCare; Cephalon, Inc.; Daiichi-Sankyo Co.; Genentech, Inc.; Merck & Co., Inc.; Millennium Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; Allos; Eli Lilly/ImClone; Zenyaku; Pfizer Inc.; and sanofi-aventis U.S. Dr. Sasson: Speaker bureau member for Novartis Pharmaceuticals Corporation. The NCCN Guidelines Staff have no conflicts to disclose. Supported by educational grants from Eisai, Inc.; Millennium: The Takeda Oncology Company; Teva Pharmaceuticals; Bayer HealthCare Pharmaceuticals Inc.; Celgene Corporation; Endo Pharmaceuticals and HealthTronics; Genentech; and ARIAD Pharmaceuticals, Inc.