Gastric cancer is not a top‐10 malignancy in the United States but represents one of the most common causes of cancer death worldwide. Biological differences between tumors from Eastern and Western countries add to the complexity of identifying standard‐of‐care therapy based on international trials. Systemic chemotherapy, radiotherapy, surgery, immunotherapy, and targeted therapy all have proven efficacy in gastric adenocarcinoma; therefore, multidisciplinary treatment is paramount to treatment selection. Triplet chemotherapy for resectable gastric cancer is now accepted and could represent a plateau of standard cytotoxic chemotherapy for localized disease. Classification of gastric cancer based on molecular subtypes is providing an opportunity for personalized therapy. Biomarkers, in particular microsatellite instability (MSI), programmed cell death ligand 1 (PD‐L1), human epidermal growth factor receptor 2 (HER2), tumor mutation burden, and Epstein‐Barr virus, are increasingly driving systemic therapy approaches and allowing for the identification of populations most likely to benefit from immunotherapy and targeted therapy. Significant research opportunities remain for the less differentiated histologic subtypes of gastric adenocarcinoma and those without markers of immunotherapy activity.

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胃癌的治疗现状及最新进展

胃癌在美国不是前 10 位恶性肿瘤，但却是全世界最常见的癌症死亡原因之一。东西方国家肿瘤的生物学差异增加了根据国际试验确定标准治疗的复杂性。全身化疗、放疗、手术、免疫治疗、靶向治疗等均已证实对胃腺癌有效；因此，多学科治疗对治疗选择至关重要。用于可切除胃癌的三联化疗现已被接受，可以代表局部疾病标准细胞毒性化疗的平台期。基于分子亚型的胃癌分类为个性化治疗提供了机会。生物标志物，特别是微卫星不稳定性（MSI），程序性细胞死亡配体 1 (PD-L1)、人表皮生长因子受体 2 (HER2)、肿瘤突变负荷和 Epstein-Barr 病毒正在越来越多地推动全身治疗方法，并允许识别最有可能从免疫治疗中受益的人群和靶向治疗。对于分化程度较低的胃腺癌组织学亚型和那些没有免疫治疗活性标志物的组织学亚型，仍有重要的研究机会。