32
resection but who has not received any preoperative therapy.
Adjuvant chemoradiotherapy is reserved for those with incom-
plete surgery especially those with known site of high-risk
disease.- There are various options in the palliative setting, and the deci-
sion for a particular regimen should be based on patients’ gen-
eral condition, comorbidities, prior treatment history, and
local expertise. Patients should all be checked for HER2 status
in the tumors. Although no doublet regimen has shown supe-
rior efficacy to cisplatin-based regimen, regimens with
oxaliplatin, taxanes, and irinotecan have better tolerability in
general. Due to the risk of significant neutropenia with triplet,
empirical granulocyte colony stimulating factor should be
considered. - Patients in the second-line or beyond setting are usually frail,
and monotherapy with convenient schedule is preferred.
Agents used in the prior treatment lines may occasionally be
used again especially if previous good response and durable
control. Patients who are fit and have no contraindication to
anti- angiogenic agent should be considered treatment with
ramucirumab and paclitaxel if available.
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Ka-On Lam and Dora L. W. Kwong