Background:The prognosis of patients diagnosed with locally advanced and metastatic gastric and esophago-gastric junction cancer is critical. The optimal choice of systemic therapy is essential to optimize survival outcomes.Methods: A comprehensive literature review via PubMed and analysis of major oncology congresses (European Society for Medical Oncology and American Society of Clinical Oncology websites) were conducted to ascertain the current status and latest developments in the systemic treatment of patients with localized or advanced gastric and esophago-gastric junction adenocarcinoma.Results: While neoadjuvant and perioperative chemotherapy for localized tumor stages is the preferred approach in the Western Hemisphere, adjuvant chemotherapy remains the preferred course of action in East Asia. The administration of chemotherapy, typically in the form of combinations comprising platinum and fluoropyrimidine compounds in combination with docetaxel, represents a standard of care. Investigations are underway into the potential of immunotherapy and other biologically targeted agents in the perioperative setting. To select the most appropriate therapy for advanced gastric cancer, including adenocarcinoma of the esophago-gastric junction, it is essential to determine biomarkers such as HER2 expression, PD-L1 combined positive score (CPS) (combined positive score), Claudin 18.2, and microsatellite instability (MSI). In the present clinical context, the standard first-line therapy is a combination of fluoropyrimidine and a platinum derivative. The selection of chemotherapy in combination with antibodies is contingent upon the specific biomarker under consideration.Conclusions: This article reviews the current state of the art based on recent clinical trial results and provides an outlook on the future of systemic therapy.
背景：局部晚期及转移性胃癌与食管胃结合部癌患者的预后至关重要，系统性治疗的最佳选择对改善生存结局具有决定性意义。 方法：通过PubMed数据库进行系统性文献检索，并结合欧洲肿瘤内科学会和美国临床肿瘤学会等主要肿瘤学会议资料，综合分析局部进展期及晚期胃腺癌与食管胃结合部腺癌系统性治疗的现状与最新进展。 结果：在西方国家，局部进展期肿瘤的新辅助及围手术期化疗已成为标准治疗方案，而东亚地区仍以辅助化疗为主要策略。以铂类联合氟尿嘧啶类药物为基础、联合多西他赛的化疗方案是目前公认的标准治疗方案。当前研究正积极探索免疫治疗及其他生物靶向药物在围手术期治疗中的应用潜力。针对晚期胃癌（包括食管胃结合部腺癌）的治疗决策，必须依据HER2表达、PD-L1联合阳性评分、Claudin 18.2及微卫星不稳定性等生物标志物进行精准选择。现阶段临床实践中，氟尿嘧啶联合铂类化疗仍是一线治疗的基础方案，而联合抗体药物的选择则取决于特定生物标志物的表达状态。 结论：本文基于最新临床试验结果综述当前治疗现状，并对系统性治疗的未来发展方向进行展望。
Systemic Therapy of Gastric Cancer—State of the Art and Future Perspectives
肿瘤(癌症)患者之家