Quality of life versus survival benefits in patients with HER-2 negative metastatic gastric cancer: exploration of the randomized trials from the patient’s perspective

Despite the significant advances in diagnosis and therapy of gastric cancer (GC), and well developed screening programmes in countries such as Japan and South Korea, this tumor remains the fifth most common malignancy and the third leading cause of cancer mortality worldwide (1,2). Most of the cases are diagnosed in advanced stages with a 5-year survival rate ranging from 20% to 27% (2,3) and median survival of 6–15 months in metastatic cases (4). Moreover, even in patients with early gastric cancer cancer (EGC), aberrant metastatic behaviour and occurence of skip metastasis are reported (5-7). Other changes related on the GC are the following: increase proportion of cases located in the upper third of the stomach, especially for young patients (1,5), changing spectrum of the histogenetic pathways (8), and progressive augmentation of the poorly-cohesive/diffuse type carcinomas and neuroendocrine variants (1,3,7-10). All of these characteristics and resistance of GC cells upon most of the target chemotherapic agents increase the therapeutically difficulty.