Stomach cancer research
This page of the stomach cancer section is about research into the causes, prevention and treatments of stomach cancer. You can find information on
Stomach cancer research
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know they are safe. First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials.
Researchers are looking into prevention and causes of stomach cancer, finding out how far a cancer has grown, surgery, chemotherapy, biological therapies, controlling symptoms and preventing weight loss.
All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
- We can be sure they work
- We can be sure they work better than the treatments we already have
- They are known to be safe
First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.
Tests in patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our clinical trials database of trials recruiting in the UK. Pick 'stomach' from the drop down menu of cancer types. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team.
Remember - all these new approaches are the subject of ongoing research. Until studies are completed that show these new treatments to be effective, they cannot be used as standard therapy for stomach cancer.
Researchers think that some people may have an inherited faulty gene that might increase their risk of developing stomach cancer. A study is currently looking at people who have 2 or more relatives with stomach cancer to see if they have genetic faults. They are also looking for any genetic faults in people who were diagnosed with stomach cancer before the age of 50.
The researchers hope to identify genes that may increase the risk of stomach cancer developing. While it is open and recruiting this trial will be listed on our clinical trials database. Choose 'stomach' from the drop down list of cancer types.
Research into preventing cancer with drugs or other agents is called 'chemoprevention'. Research is looking at using
to help prevent stomach cancer.
Antioxidants
Eating a diet high in fresh fruit and vegetables seems to prevent stomach cancer. Some scientists believe that antioxidant vitamins and minerals may help prevent cancer when included in a healthy, balanced diet. These antioxidants, and other substances in fresh foods, may help to prevent damage to the stomach lining that can lead to cancer. We do not know for sure whether eating these can help prevent cancer, because this is a very difficult thing to prove. In theory, antioxidants help to prevent body cells being damaged by oxygen particles called free radicals. The damage can lead to the cells becoming cancerous.
Antibiotics
Clinical trials are looking at whether giving antibiotics to people who have a chronic infection of the bacteria Helicobacter pylori will help prevent stomach cancer. Helicobacter pylori (HP) is a known cause of stomach cancer. But most people who have this infection will not develop stomach cancer. So there must be other factors at work. Doctors need to know exactly what the risk is, or many people at low or no risk of stomach cancer would be treated with antibiotics that they didn't really need.
Some research has looked into screening for Helicobacter Pylori. People found to have the infection were treated and everyone in the trial is being followed up to see who develops stomach cancer in the future. It is easier to screen for HP than it is for stomach cancer - it just takes a breath test. But it will take many years before we know if HP screening is effective in helping prevent stomach cancer.
Diet
The incidence of stomach cancer varies from country to country around the world. This may be explained to some extent by differences in diet. A diet high in very salty foods increases the risk of stomach cancer. Stomach cancer levels are very high in Japan where very salty pickled foods are popular. But these foods are not typically eaten in the UK and stomach cancer rates here are lower than they are in Japan.
Smoked, barbecued, and preserved foods may also increase risk of stomach cancer. Preserved foods include cured meats, such as bacon and ham. A diet high in fresh fruit and vegetables may lower risk of stomach cancer.
We need much more detailed information about the link between diet and cancer. So a major study is going on in the UK and 8 other European countries, into the links between diet and cancer. This study is called The European Prospective Investigation of Cancer (EPIC). The trial started in 1992 and it will be producing reports on diet and a variety of cancers over the next 10 to 20 years. There is more information about diet and cancer in the cancer and causes section of CancerHelp UK.
At the moment doctors use a number of tests to stage stomach cancer. These include endoscopy and endoscopic ultrasound. PET-CT scans are sometimes used to see if they can help to find the stage of the tumour more accurately.
In some European countries, trials are being carried out to see how well PET-CT scans work in diagnosing and staging stomach cancer. PET-CT scans use an injection of a slightly radioactive liquid into a vein to show up areas of cancer. This scan is combined with a CT scan, which uses a series of X-rays to buld up a picture of an area of the body.
Surgery for stomach cancer is usually done through a cut into the abdomen (laparotomy). Laparoscopy is already used to help stage stomach cancers and there is increasing interest in using it to treat stomach cancer. Laparoscopy looks into the stomach using a tube passed through a small cut. There is less scarring after laparoscopic surgery and time spent in hospital is generally shorter. Some studies show that patients feel better more quickly afterwards. But it is not suitable for people with larger cancers or advanced disease.
A new type of laparoscopic surgery combines an endoscopy with a laparoscopy. This is called laparo-endogastric surgery or 'laparoscopic resection'. Because it is a new procedure we don’t yet know how good it is at removing cancer.
The National Institute for Health and Clinical Excellence (NICE) have issued guidance on laparo-endogastric surgery. They say that there is not yet enough evidence on how safe or effective it is. And that doctors should make sure that patients are aware of these uncertainties. They also recommend that laparo-endogastric surgery should only be carried out by doctors specialised in laparoscopic surgery.
A technique developed in Japan is also being tried by some doctors in the UK. The surgeon removes the tumour using an endoscope that can greatly magnify the area. Acetic acid liquid is used to show up the area of the tumour more clearly. This operation is called endoscopic submucosal dissection. It is not yet clear how well this technique works.
Doctors are keen to find out whether giving chemotherapy or radiotherapy (or both) after surgery for stomach cancer will help to stop cancers from coming back and so improve survival rates.
A trial called MAGIC looked at treating people with operable stomach cancer with chemotherapy before and after surgery. This is called peri-operative chemotherapy. Results showed that chemotherapy helped to reduce the size of the cancer and made it easier to remove fully with surgery. Having chemotherapy before and after surgery also helped stop the cancer coming back and helped people live longer.
Research has looked into using chemotherapy and radiotherapy together to see if it can help stop stomach cancer from coming back after surgery. Having both treatments can be difficult to cope with when recovering from a big operation. We need more research before we know whether this treatment really would help. Until then, it is not used routinely, and should only be used as part of a clinical trial.
At the moment, chemotherapy is mainly used to try to shrink and control advanced stomach cancers. Doctors are always trying to get better response rates. So they test new drugs and new combinations of drugs.
Doctors are testing the standard ECF regimen with a drug called decitabine which may make the cancer cells more sensitive to treatment. This is an early phase trial for people with advanced stomach cancer.
The COUGAR-02 trial is looking at how well docetaxel works for people with advanced stomach cancer who have already had one course of chemotherapy that has not shrunk the tumour, or the tumour has come back afterwards.
The PEP0206 study is looking at irinotecan, docetaxel and a new chemotherapy called PEP02 for advanced cancer of the stomach that has continued to grow after previous chemotherapy.
If you are interested in any of these clinical trials, or other trials for stomach cancer, please visit our searchable clinical trials database. Choose 'stomach' from the drop down list of cancer types.
Biological therapies are treatments that are developed from natural body substances. There is research into
Monoclonal antibodies
A monoclonal antibody (MAB) is a protein made in the laboratory from a single copy of a human antibody. The REAL3 trial is looking at a MAB called panitumumab (or Vectibix). This drug acts like a growth factor blocker. Doctors want to find out if EOX chemotherapy (epirubicin, oxaliplatin and capecitabine) works better against advanced stomach cancer if panitumumab is given with it. You may be able to join this trial if you have stage 3 or 4 stomach cancer which cannot be treated with surgery or combined chemotherapy and radiotherapy. You can find out more about this trial on our clinical trials database.
Monoclonal antibodies can target growth factors that encourage blood vessels to grow. Drugs that stop new blood vessels growing are called antiangiogenics. (Angiogenesis means growth of blood vessels.) Cancers need to grow their own blood vessels so that they can be sure of getting enough food and oxygen. If there aren't blood vessels carrying these nutrients into the centre of the tumour, it will die. A trial is looking at whether a monoclonal antibody called bevacizumab (Avastin) can make chemotherapy work better for advanced stomach cancer before and after surgery. Avastin blocks a growth factor protein called VEGF. VEGF promotes blood vessel growth.
Some early research has looked into using a monoclonal antibody in combination with a drug called combretastatin. Combretastatin works by blocking the blood supply to the cancer, so it can't grow. The monoclonal antibody used in this research has radioactive iodine attached to it to help kill the cancer cell. This is called radioimmunotherapy. Researchers want to find out if this combination of treatment will target stomach cancers and stop them growing by blocking their blood supply. This trial has closed and we are waiting for the results.
A small trial in Manchester tested a MAB called CP 675 206 in patients whose stomach cancer had come back after treatment. The trial aims to find out if CP 675 206 is effective against cancer cells in the stomach, but it is a very new treatment and doctors are not sure how well it will work. This trial has now closed and we are waiting for the results.
Some cancers produce too much of a protein called HER2. This protein signals to the cell to grow. A monoclonal antibody called trastuzumab (Herceptin) kills cancer cells that produce too much HER2. Researchers are looking into giving trastuzumab to people who have advanced stomach cancer which is HER2 positive. A phase 3 trial is comparing people who have chemotherapy with and without trastuzumab. The trial has finished recruiting people and the results are not available yet.
Drugs to block cancer growth signals
There are receptors on the surface of body cells that are triggered by growth chemicals. Cancer cells usually have too many receptors, which is one reason why they grow too fast and in an uncontrolled way. Drugs that block these receptors are called 'inhibitors'.
Two of the groups of chemicals that encourage cell growth are called protein kinases and tyrosine kinases. Imatinib and lapatinib (Tyverb) are tyrosine kinase inhibitors being tested for advanced stomach cancer in the US. This research is in its early stages. We know the drugs are safe enough to use, but don't know if they will help to treat stomach cancer.
Bortezomib (Velcade)
Bortezomib is a type of biological therapy called a proteasome inhibitor. Proteasomes are substances that help break down proteins. They are in all cells. Bortezomib interferes with the way proteosomes work, making protein build up and the cells die. Trials have shown that bortezomib also makes cancer cells more sensitive to some types of chemotherapy. A new trial is looking into how well bortezomib works, with chemotherapy, in advanced stomach cancer. You may be able to join this trial if you have stomach cancer that cannot be surgically removed.
Everyone on the trial has up to 8 cycles of EcarboX chemotherapy. This is epirubicin, carboplatin and capecitabine (Xeloda). You will also have bortezomib. People on the trial will have different doses of bortezomib. This is so the researchers can find out the best dose to give, and learn more about the side effects of this treatment. There is more information about this trial on our clinical trials database.
Researchers also help to develop new treatments for symptoms, such as pain and sickness. Nerve blocks are sometimes used to help control pain in digestive system cancers. A trial is comparing nerve blocks with painkillers to see which is most effective at controlling pain in stomach cancer. To find this trial, go to our clinical trial database and pick 'stomach' from the drop down list of cancer types.
Stomach cancer and its treatment usually causes weight loss. People who lose too much weight often find it harder to cope with chemotherapy treatment and may get side effects sooner. So research is increasing into ways of stopping people losing too much weight. Severe weight loss is called cachexia. This is a complex problem that involves changes in metabolism and can lead to muscle wasting. A trial is looking at using the drug thalidomide to help slow down or stop cachexia.
There is more information about this trial on our clinical trials database. Type 'thalidomide' into the free text search box.
There is more information about diet problems in the section on coping physically with cancer of CancerHelp UK.
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