New therapeutic options opened by the molecular classification of gastric cancer

Core Tip

Core tip: A new molecular classification of gastric cancer (GC) became available after publication of three landmark studies: The Cancer Genome Atlas, “Singapore-Duke” study, and Asian Cancer Research Group, allowing patient selection for specific targeted therapy. The Epstein-Barr virus positive, microsatellite stable TP53-active or microsatellite-unstable tumors subtypes presents tumour infiltrating patterns with overexpression of PD-1, PD-L1, PDL-2. Preliminary data show high response rate to immunotherapy and open new avenues to gene therapy. Currently effective therapies for diffuse GC are lacking. Mutations in e-cadherin and Ras homolog family member A genes, or Claudin-18-ARHGAP6/26 fusions may be exploited as therapeutic targets. The only targeted therapies approved so far for chromosomal instability and microsatellite stable TP53-inactive subtypes of GC are trastuzumab and ramucirumab (HER2 and VEGFR2 inhibitors).