Advances in molecular, genetic and immune signatures of gastric cancer: Are we ready to apply them in our patients’ decision making?

Abstract

In the last few years we have witnessed a vast expansion of our knowledge regarding the molecular and genetic profile of gastric cancer. The molecular subtypes described have shed light on the pathogenesis of the disease, thus prompting the development of new therapeutic strategies and favoring a more individualized approach for treatment. Most of the clinical trials for so called targeted therapies could be considered, at best, partially successful. In addition, checkpoint inhibitors have recently been added to our armamentarium in later stages of the disease, and combinations with chemotherapy and targeted agents are currently under development. In view of the rapid advances of molecular oncology, a new challenge for the clinical oncologist arises: The appropriate patient selection for each new therapy, which can be made possible only through the implementation of predictive biomarkers in our therapy decision making.

Keywords: Gastric cancer; Cancer Genome Atlas; Asian Cancer Research Group; Targeted therapy

Core tip: Despite recent advances in cancer therapeutics, the survival of gastric cancer patients with metastatic disease is dismal due to the complexity of the disease, the constant evolution of tumors and our still limited understanding of its biology. It is evident that a wide spectrum of prognostic and predictive biomarkers is needed in order to rationalize our decisions when managing patients with this specific tumor type and tailor our treatment to suit better the individual patient’s unique needs.