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Standard first-line chemotherapy for metastatic gastric cancer combines a fluorinated pyrimidine with a platinum agent; second-line therapy is paclitaxel and ramucirumab, and third-line is irinotecan. Trastuzumab is added to first-line chemotherapy in HER2-positive disease. Pembrolizumab is approved in the U.S. for PD-L1–positive, chemotherapy-refractory disease.
Whether docetaxel should be combined with first-line fluorinated pyrimidine and platinum chemotherapy, given the higher toxicity, is controversial. Japanese investigators now report results of JCOG1013, an open-label, multicenter, phase III, randomized trial in metastatic gastric cancer, comparing the combination of S-1 and cisplatin with or without the addition of docetaxel. Of the…