J.Jpn. Surg. Soc.. 126(3): 267-274, 2025

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Feature topic

THE ROLE OF BIOMARKERS IN DRUG SELECTION FOR ADVANCED GASTRIC CANCER TREATMENT

The treatment of advanced and recurrent gastric cancer has evolved significantly in recent years. Along with the established anti-HER2 antibody drug trastuzumab and the immune checkpoint inhibitor nivolumab, new therapies such as the anti-Claudin18.2 antibody drugs zolbetuximab and pembrolizumab, which have been approved as first-line therapy, have expanded treatment options. As these options grow, biomarker testing has become essential to provide patients with the most effective, personalized treatments. The Japanese Gastric Cancer Association has issued guidelines recommending the evaluation of four key biomarkers, HER2, PD-L1, MSI/MMR, and CLDN18, prior to initiating first-line therapy. However, in some institutions, it may be challenging to perform all four tests due to resource limitations. In such cases, prioritizing biomarker testing based on their relevance to treatment planning is critical. Additionally, for patients with multiple positive biomarkers, determining the optimal treatment strategy requires further data from clinical trials. Biomarker-driven approaches are expected to accelerate the adoption of personalized medicine in gastric cancer treatment. Nevertheless, continued advances in both clinical and basic research are essential to refine treatment strategies and improve outcomes.

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