Standard of Care and Treatment Challenges in Gastric Cancer

This discussion provides an overview of current treatment standards and practical challenges in managing advanced gastric cancer. The discussion emphasizes that platinum–fluoropyrimidine doublet chemotherapy remains a widely used first-line backbone because it offers an effective balance of efficacy and tolerability. Experts also address ongoing debate around taxane-containing triplet regimens, noting that while certain regional studies have evaluated them, concerns about added toxicity and inconsistent benefit have limited their routine use in many practices. The segment highlights the importance of tailoring treatment to individual patient factors, including performance status, comorbidities, prior therapies, and patterns of spread such as peritoneal involvement or positive peritoneal cytology. It also reinforces that upfront surgery is generally not appropriate in stage IV disease and stresses the need for thorough staging and multidisciplinary coordination. Overall, this segment provides practical insights into evidence-based and individualized decision-making in advanced gastric cancer care.