Overview
Gastric cancer (GC) is the fifth most common cancer globally, characterized by aggressive behavior and varied geographic incidence 1. In Spain, it is less common but remains a significant cause of cancer mortality 1. Advances in molecular biology are enabling more personalized therapeutic approaches 1.Diagnosis
Multidisciplinary team discussion is fundamental for planning the therapeutic approach in the localized setting 1.Management
Endoscopic resection is indicated for very early-stage disease 1.
Perioperative chemotherapy is recommended for locally advanced tumors 1.
For the gastroesophageal junction (GEJ), chemoradiation plus surgery plus adjuvant immunotherapy is a current standard 1.
For metastatic disease, biomarker profiling (Her2, PD-L1, MSS status) is necessary 1.
Chemotherapy combined with checkpoint inhibitors has improved outcomes for patients with PD-L1 expression 1.
Her2-positive patients should receive anti-Her2 therapy in addition to chemotherapy 1.Key Recommendations
For locally advanced gastric cancer, perioperative chemotherapy is recommended 1. (Evidence: Strong)
For metastatic gastric cancer, biomarker profiling including Her2, PD-L1, and MSS status is needed to guide treatment 1. (Evidence: Moderate)
In PD-L1 expressing metastatic gastric cancer, chemotherapy in combination with checkpoint inhibitors should be considered 1. (Evidence: Moderate)
Her2-positive metastatic gastric cancer patients should receive anti-Her2 therapy added to chemotherapy 1. (Evidence: Moderate)References
1 Rivera F, Longo F, Martín Richard M, Richart P, Alsina M, Carmona A et al.. SEOM-GEMCAD-TTD clinical guideline for the diagnosis and treatment of gastric cancer (2023). Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 2024. link