A Comprehensive Overview of Cardia Cancer: Exploring a Chemotherapeutic Agent and Two Targeted Therapeutics

Abstract

Cardia cancer, a subtype of gastric cancer occurring at the gastroesophageal junction, poses significant challenges due to its high malignancy, rapid progression, and tendency for metastasis and recurrence. Its development is linked to chronic gastric diseases, gastroesophageal reflux disease, and Helicobacter pylori infection. HER2 status is crucial in cardia cancer, with HER2-positive tumors benefiting from targeted therapies like Herceptin. Diagnosis relies on endoscopy, biopsy, and imaging techniques. Treatment involves chemotherapy and targeted therapies. Capecitabine, a chemotherapeutic agent, mimics continuous 5-FU infusion but with reduced gastrointestinal toxicity. It selectively accumulates in tumor tissue, inhibiting cell division by disrupting DNA and RNA synthesis. Two synthetic routes for capecitabine are described, both starting from D-ribose and utilizing distinct chemical transformations. Herceptin, a targeted therapy, binds to the HER2 receptor, inhibiting its downstream signaling pathways and promoting cell-cycle arrest and apoptosis in HER2-positive cardia cancers. However, resistance mechanisms may limit its efficacy over time. Bevacizumab targets vascular endothelial growth factor (VEGF), inhibiting angiogenesis and reducing tumor blood supply, nutrition, and metastasis. By normalizing tumor vasculature, bevacizumab enhances chemotherapy efficacy. Its use with chemotherapy regimens has shown improved survival outcomes in clinical trials. Adverse effects include hypertension, proteinuria, and gastrointestinal perforation, necessitating careful patient monitoring. In conclusion, the paper provides an overview of cardia cancer, discussing its epidemiology, diagnosis, and treatment with a focus on capecitabine as a chemotherapeutic agent and Herceptin and Bevacizumab as targeted therapies. These approaches aim to improve outcomes for patients with this aggressive subtype of gastric cancer.