Metastatic gastric cancer (GC) still represents a critical clinical challenge, with limited treatment options and a poor prognosis. Most patients are diagnosed at advanced stages, limiting the chances of surgery and cure. The identification of molecular targets and the possibility of combining immune checkpoint inhibitors with chemotherapy have recently reshaped the therapeutic landscape of metastatic gastric cancer. The new classification of gastric cancer, mainly based on immunologic and molecular criteria such as programmed cell death 1 (PD-1), microsatellite instability (MSI), and human epidermal growth factor receptor 2 (HER2), has made it possible to identify and differentiate patients who may benefit from immunotherapy, targeted therapy, or chemotherapy alone. All relevant and available molecular and immunological targets in clinical practice for the systemic treatment of this disease are presented. Particular attention is given to possible future approaches, including circulating tumor DNA (ctDNA) for therapeutic monitoring, new targeting agents against molecular pathways such as fibroblast growth factor receptor (FGFR) and MET, chimeric antigen receptor (CAR)-T cells, and cancer vaccines. This review aims to provide a comprehensive understanding of current targets in advanced gastric cancer and to offer valuable insights into future directions of research and clinical practice in this challenging disease.
转移性胃癌（GC）仍是一项严峻的临床挑战，其治疗选择有限且预后不良。多数患者在确诊时已处于晚期，这限制了手术及治愈机会。近年来，分子靶点的识别以及免疫检查点抑制剂与化疗联合应用的可能性，正在重塑转移性胃癌的治疗格局。基于程序性死亡受体1（PD-1）、微卫星不稳定性（MSI）和人表皮生长因子受体2（HER2）等免疫与分子标志物的新型胃癌分类体系，使得识别并区分可能从免疫治疗、靶向治疗或单纯化疗中获益的患者成为可能。本文系统阐述了当前临床实践中用于该疾病全身治疗的所有相关可用分子与免疫靶点，并重点关注了未来可能的发展方向，包括用于治疗监测的循环肿瘤DNA（ctDNA）、针对成纤维细胞生长因子受体（FGFR）和MET等分子通路的新型靶向药物、嵌合抗原受体（CAR）-T细胞以及癌症疫苗。本综述旨在全面阐述晚期胃癌的现有治疗靶点，并为这一具有挑战性疾病的未来研究方向与临床实践提供有价值的见解。
肿瘤(癌症)患者之家