Current Treatment Standards and Ongoing Challenges in Gastric Cancer

This discussion provides a clear overview of current treatment standards and ongoing challenges in the management of advanced gastric cancer. The discussion outlines how first-line therapy is anchored in HER2 status: patients with HER2-positive tumors receive HER2-targeted therapy combined with chemotherapy, while those with HER2-negative disease are treated with a PD-1 inhibitor plus platinum-based chemotherapy. PD-L1 expression, often measured using the combined positive score (CPS), helps refine decisions regarding the use of immunotherapy, with higher CPS values generally associated with greater benefit. The segment emphasizes the importance of obtaining HER2 and PD-L1 results early through comprehensive molecular profiling to guide individualized treatment selection. It also addresses one of the most difficult clinical issues in gastric cancer, peritoneal metastases, which are common, frequently hard to detect with imaging, and associated with poor outcomes. These factors highlight the complexity of caring for this population despite improvements in systemic therapy.