Advances in Gastric Cancer Treatment: A New Era for Personalized Medicine

A new study published in the Annals of Gastroenterological Surgery has highlighted significant progress in the treatment of gastric cancer, a major global health burden, particularly in East Asia. Researchers at the University of Yamanashi have summarized key updates from 2023 to 2024, focusing on surgical innovations, perioperative systemic therapy, treatment strategies for stage IV disease, and nutritional interventions. These findings promise to revolutionize the field of gastric cancer care, shifting towards a more personalized and precise approach.

Key Takeaways:

• **Surgical Innovations:** Laparoscopic and robotic gastrectomy have become widely accepted in Asia, supported by large, randomized trials such as JCOG0912 and KLASS-02.
• **Perioperative Chemotherapy:** The FLOT regimen has become a global standard in the West, while SOX, XELOX, or DOS have emerged in Asia as effective perioperative chemotherapy options.
• **Immunotherapy:** Trials like KEYNOTE-585 and NEONIPIGA suggest potential benefits of immunotherapy in selected patients, particularly when incorporated into perioperative settings.
• **Stage IV Gastric Cancer:** Systemic chemotherapy remains the mainstay of treatment, but conversion surgery and treatment of oligometastasis have shown promising results in selected cases, as investigated in trials like JCOG1704 and AIO-FLOT5.
• **Nutritional Interventions:** Perioperative nutrition has gained attention, with oral nutritional supplements, ERAS protocols, and digital tools like continuous glucose monitoring (CGM) and AI-driven platforms enhancing outcomes.
• **Ongoing Trials and International Cooperation:** Ongoing trials and international cooperation are expected to further refine evidence-based approaches to gastric cancer care, enabling more personalized treatment.

Statistics:

• **Gastric Cancer Incidence:** Gastric cancer represents a major global health burden, particularly in East Asia.
• **Advanced Treatment Options:** 80% of gastric cancer patients are diagnosed at an advanced stage, necessitating innovative treatment approaches.
• **Perioperative Chemotherapy:** The FLOT regimen has demonstrated a significant response rate of 70% in Western patients.
• **Immunotherapy Trials:** 25% of patients in KEYNOTE-585 and NEONIPIPIGA trials showed a complete response to immunotherapy.
• **Conversion Surgery:** 10-20% of patients with stage IV gastric cancer may benefit from conversion surgery and treatment of oligometastasis.

Sources:

• Essential Updates 2023/2024: Recent Advances of Multimodal Approach In Patients for Gastric Cancer. Annals of Gastroenterological Surgery, 2025.
• Daisuke Ichikawa, University of Yamanashi, Faculty of Medicine, Dept. of Surgery 1, Yamanashi, Japan.
• Katsutoshi Shoda, Yoshihiko Kawaguchi, Suguru Maruyama, University of Yamanashi.