Table 6. Palliative systemic treatments.
| Palliative systemic treatment | KGCA (2018) | JGCA (2018) | CSCO (2021) | NCCN (2021) | ESMO (2016) | |
|---|---|---|---|---|---|---|
| First-line | ||||||
| HER2-negative | Platinum + fluoropyrimidine | SP, XP, SOX, XELOX, FOLFOX | Oxaliplatin + fluoropyrimidine | FOLFOX/XELOX + nivolumab (PD-L1 CPS ≥5) | Platinum + fluoropyrimidine | |
| Paclitaxel/docetaxel + fluoropyrimidine | Fluoropyrimidine (5-FU or capecitabine) + oxaliplatin | Platinum + fluoropyrimidine + taxanes | ||||
| Cisplatin + fluoropyrimidine | ||||||
| FOLFOX/XELOX + nivolumab (PDL1 CPS ≥5) | ||||||
| HER2-positive | Trastuzumab + XP or FP | Trastuzumab + XP Trastuzumab + SP | Trastuzumab + oxaliplatin/cisplatin + 5-FU/capecitabine | Trastuzumab + XP or FP | Trastuzumab + platinum + fluoropyrimidine | |
| Second-line | Ramucirumab + paclitaxel | Ramucirumab + paclitaxel | Paclitaxel | Ramucirumab + paclitaxel | Taxane | |
| Taxane | Docetexal | Docetaxel | Irinotecan | |||
| Irinotecan | Irinotecan | Paclitaxel | Ramucirumab | |||
| Ramucirumab | Irintecan | Irinotecan + paclitaxel | ||||
| Trastuzumab + deruxtecan for HER2-positive | Ramucirumab + paclitaxel | |||||
| 5-FU + irinotecan | ||||||
| Third-line | Nivolumab | Nivolumab | Apatinib | TAS-102 | TAS-102 | |
| Irinotecan | Irinotecan | Nivolumab | Pembrolizumab (PDL1 CPS ≥1) | |||
| Taxane | ||||||
| Pembrolizumab | ||||||
This table only includes JGCA “Recommend regimens,” CSCO “Grade I recommendations,” and NCCN “Preferred Regimens.”
KGCA = Korean Gastric Cancer Association; JGCA = Japanese Gastric Cancer Association; CSCO = Chinese Society of Clinical Oncology; NCCN = National Comprehensive Cancer Network; ESMO = European Society for Medical Oncology; HER2 = human epidermal growth factor receptor 2, SP = S-1 and cisplatin; XP = capecitabine and cisplatin; SOX = S-1 and oxaliplatin; XELOX = capecitabine and oxaliplatin; FOLFOX = 5-fluorouracil, leucovorin, and oxaliplatin; PD-L1 = programmed cell death-ligand 1; CPS = combined positive score; 5-FU = 5-fluorouracil; FP = 5-fluorouracil and cisplatin; TAS-102 = Trifluridine and tipiracil.