J.Jpn. Surg. Soc.. 124(3): 253-260, 2023

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Feature topic

PRECISION MEDICINE FOR GASTRIC CANCER

The Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition) recommend regimens for the first-, second-, third-, fourth-, or later line treatments. Only three biomarkers are currently being used in routine clinical practice for the selection of patients with advanced-stage gastric and gastroesophageal junction (G/GEJ) cancers to receive targeted therapies: HER2 positivity for trastuzumab and T-DXd, and MSI status and PD-L1 expression for anti-PD-1 antibodies. Distinct molecular subtypes of G/GEJ cancers have been identified and informed the development of novel agents, including receptor tyrosine kinase inhibitors and monoclonal antibodies, several of which are currently being tested in ongoing clinical trials. Biomarker-based selection of targeted therapies has been developed using comprehensive molecular profiling strategies that include immunohistochemistry and sequencing of tumor tissue and/or circulating tumor DNA. Precision medicine has been structured not only for unresectable advanced/recurrent gastric cancer but also for resectable advanced cancer in the form of neoadjuvant chemotherapy followed by surgery. Additional considerations and countermeasures of spatial and temporal genomic heterogeneities will be necessary to develop precision medicine.

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