Advanced Gastric Cancer Treatment for International Patients

Advanced gastric cancer treatment in India

The following is a brief summary of the treatment choices that are available in the case of advanced gastric cancer (stomach cancer) based on the stage, spread, and the health status of the patient:

Systemic Therapies

They are administered when the cancer has gone further than the stomach or when it is not possible to administer surgery.

Chemotherapy

• Standard backbone of advanced gastric cancer treatment.
• Common drugs: 5-FU, capecitabine, oxaliplatin, cisplatin, irinotecan, paclitaxel, docetaxel.
• Frequently used as combinations (e.g., FOLFOX, XELOX, DCF).
• Used: to relieve symptoms, to extend life, to shrink tumors prior to surgery (neoadjuvant).

Targeted Therapy

• HER2-positive: Trastuzumab (Herceptin) + chemo.
• VEGFR2 pathway: Ramucirumab (as mono- or combination therapy with paclitaxel) to prevent the expansion of blood vessels.
• Tumors expressing Claudin 18.2: Zolbetuximab (new targeted therapeutic agent, approved in certain countries).

Immunotherapy

PD-1 inhibitors:

• Nivolumab or Pembrolizumab on tumors, which have the PD-L1 or MSI-H (microsatellite instability-high) phenotype.
• Enhances survival in patients receiving chemo in combination with improves overall survival.

Surgery (for Select Advanced Cases)

• In the case of the locally advanced, yet not extensively metastatic cancer, gastrectomy (part of the stomach or entire stomach removal) and lymph node removal can be considered.
• Cytoreductive surgery + HIPEC (heated chemotherapy inside abdomen): It is already under clinical evaluation in select patients with peritoneal metastases.

Radiation Therapy

• Less frequently used to treat gastric cancer than other cancers.
• May be used to treat pain, bleeding, or obstruction (palliative).
• Local control is sometimes done with combination of chemo (chemoradiation).

Palliative & Supportive Care

• Endoscopic stenting or bypass surgery for obstruction.
• Nutritional support (TPN, feeding tubes, feeding tubes, etc.).
• Psychological support for patient and family.

Emerging & Clinical Trials

• CAR-T cell therapies (under study for gastric cancer).
• Cancer vaccines and new checkpoint inhibitors.
• Immunotherapy (chemo + immunotherapy).

Best hospitals for gastric cancer in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Factors Affecting Gastric cancer treatment cost in India

The issues that influence the cost of cancer treatment (advanced/gastric/stomach) in India and then a hint of how this cost changes and how you can control it. Major Considerations that affect the cost of treatment:

Cancer & Patient-Specific Factors

Type & Stage of Cancer

• Developed stages or aggressive histologies (e.g., diffuse type) will require multi-modality therapies, including surgery, chemo, radiation, targeted and immunotherapy, which may contribute importantly to the overall cost. 

General Health and Comorbidity of patient

• Other comorbidities such as diabetes or hypertension can require additional tests or care, and this adds to overall cost. 

Treatment Modalities

Surgical Approach

• Open or laparoscopic operations are cheaper, whereas robotic-assisted operations may cost an upward. 

Chemotherapy

• The price per cycle varies in general based on regimen and hospital. 

Radiation Therapy

• Techniques like IGRT or IMRT cost more. 

Targeted Therapy (e.g. HER2-directed reagents)

• The total cost can be stretched to annual costs. 

Immunotherapy

• Annual treatment is the most expensive and may cost more. 

HIPEC (Hyperthermic Intra-peritoneal Chemotherapy)

• The cost is added to by an expensive and specialized procedure. 

Hospital and Infrastructure Influences

Type of Hospital (Public vs Private; Accreditation)

• Approved non-governmental facilities (e.g., JCI, NABH) are usually more expensive. 

Hospital's Reputation & Location

• Metro cities (e.g., Delhi, Mumbai, Bengaluru) tend to charge more in general treatment- compared with lower charges in small cities. 

Accommodation & Hospital Stay Duration

• There is an addition of single rooms, ICUs, or extended-stay to the total bill. 

Diagnostic & Supportive Costs

Diagnostic Workup

• The cumulative cost of endoscopy, CT/MRI, biopsies, labs may run several lakhs. 

Pre- and Post-operative Care

• Drugs, regular check-ups, rehabilitation, and treatment of complications such as infections or leaks aren’t cheap.

Advanced stomach cancer therapies in India

Here is a clear lineup of the most recent and superior treatments of stomach (gastric) cancer particularly in any of the more severe or metastatic phases:

Chemotherapy – Backbone of Treatment

• Still the primary systemic therapy.

Common regimens:

• FOLFOX / XELOX (5-FU/capecitabine + oxaliplatin)
• DCF (docetaxel + cisplatin + 5-FU)
• Regimens with paclitaxel + irinotecan.
• Role: Shrinks tumors, relieves symptoms, prolong survival.

Targeted Therapies

• These act on specific tumor biomarkers. Molecular testing (HER2, VEGFR, Claudin18.2, etc.) is normally required in patients.
• HER2-positive gastric cancer
• Trastuzumab (Herceptin) with chemo → standard first-line.
• trastuzumab deruxtecan (T-DXd) → post progression.
• VEGFR2 pathway (angiogenesis inhibitors)
• Ramucirumab (paclitaxel or alone) is better in 2nd line.
• Claudin 18.2–positive gastric cancer
• Zolbetuximab (recently approved in certain countries) → in combination with chemo a promising result is shown.
• Other investigational targets: FGFR2, MET, EGFR.

Immunotherapy

• Immune checkpoint inhibitors are altering the fortunes in some selected patients.

PD-1 inhibitors:

• Nivolumab + chemo (first-line, especially PD-L1 positive tumors).
• Pembrolizumab for MSI-H (microsatellite instability-high) or PD-L1 positive cases.
• In combination, CTLA-4 inhibitors (such as ipilimumab) are under trial.

Locoregional Advanced Options

• Surgery Select Cases: Although surgery (total/partial gastrectomy with lymphadenectomy) may be considered in the presence of widely metastatic disease, it may be used in the case of locally advanced but not widely metastatic disease.
• HIPEC (Hyperthermic Intraperitoneal Chemotherapy): In peritoneal dissemination--experimental but beneficial in a portion of the patients.

Radiation & Palliative Approaches

• Chemoradiation: Less prevalent, employed to the local control of non-surgical patients.
• Palliative radiation: Controls bleeding, pain, or obstruction.
• Endoscopic therapies: Stents or bypass surgery for obstruction.

Emerging & Experimental Therapies (Clinical Trials)

• CAR-T cell therapy (claudin18.2, HER2 and other antigens).
• Cancer vaccines (personalized, under research).
• Oncolytic viruses (man-made viruses to assault tumor cells).
• Bispecific antibodies (interact with tumor antigens with immune cells).

Chemotherapy for advanced gastric cancer

The following is an organized summary on chemotherapy of advanced gastric (stomach) cancer:

Role of Chemotherapy

• Mainstay treatment for advanced or metastatic gastric cancer.

Used to:

• Shrink tumors.
• Improve symptoms (pain, bleeding, obstruction).
• Extended life (but it is difficult to treat in advanced stages).
• May be used in combination with biomarker-based targeted therapy or immunotherapy.

Commonly Used Drugs

• Fluoropyrimidines: 5-fluorouracil (5-FU), capecitabine, S-1.
• Platinum compounds: Cisplatin, oxaliplatin, carboplatin.
• Taxanes: Docetaxel, paclitaxel.
• Camptothecins: Irinotecan.
• Anthracyclines: Epirubicin (is not frequently used nowadays).

Standard Chemotherapy Regimens

First-Line (initial treatment)

• FOLFOX: 5-FU + leucovorin + oxaliplatin.
• XELOX (CAPOX): Capecitabine + oxaliplatin.
• FLOT: 5-FU + leucovorin + oxaliplatin + docetaxel.
• Cisplatin + 5-FU (classic regimen).
• Cisplatin + capecitabine.
• In case of HER2-positive, trastuzumab is used with chemo.
• In case of PD-L1 positive or of MSI-H, immunotherapy can be added.

Second-Line (disease progression)

• Paclitaxel + ramucirumab (targeted drug) → common.
• Irinotecan or docetaxel alone.

Third-Line and Beyond

• Trifluridine/tipiracil (TAS-102) – approved in certain areas.
• Paclitaxel, irinotecan, or experimental agents in clinical trials.

Mode of Administration

• IV infusions (5-FU, cisplatin, oxaliplatin, paclitaxel).
• Oral options (capecitabine, S-1, trifluridine/tipiracil).

Top gastric cancer specialists in India

• Dr. Tapan Singh Chauhan
• Dr. Mukesh Patekar
• Dr. Ashok Kumar Vaid
• Dr. Kunjahari Medhi
• Dr. Randhir Sud
• Dr. Adarsh Chaudhary
• Dr. Vedant Kabra
• Dr. Ankur Bahl

Advanced gastric cancer treatment in India with GetWellGo

Access to Top-Tier Hospitals

GetWellGo also collaborates with a large number of reputed hospitals in India, particularly in metropolitan regions such as Gurugram, well-known in the treatment of gastric (stomach) cancer. Examples include:

• Fortis Memorial Research Institute (Gurugram): Provides minimally invasive surgery, HIPEC, targeted treatment, and gastrectomy.
• Network of hospitals (e.g., Medanta, Artemis, Max) that provide access to multidisciplinary oncology team and state-of-the-art treatment. 

Comprehensive Support Services

GetWellGo assists with:

• Transparent and comparative treatment cost estimates.
• Individualized development of treatment plans with the coordination of hospitals.
• Medical visa applications, travel, accommodation and translation services. 

Available Modalities of treatment

Via their partner hospitals, you can access:

• Surgical Alternatives: laparoscopic gastrectomy or robotic gastrectomy, even HIPEC with some peritoneal metastases.
• Systemic Therapies: Immune Therapy based on biomarker testing, Chemotherapy, Targeted Therapy.
• Radiation Therapy: IMRT, palliative or curative, as required.

Why Choose GetWellGo for Gastric Cancer Treatment?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Gastric Cancer treatment.
• Expert GI oncologists with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food