Novel Therapies in the Perioperative Management of Localized Gastric Cancer: Current Perspectives and Future Directions

Resumo

The management of localized gastric cancer has evolved considerably with the advent of novel perioperative treatment strategies with chemotherapy, significantly impacting patient outcomes. Traditionally, surgery has been the cornerstone of treatment, but recurrence rates remained high, necessitating the exploration of additional therapies to enhance long-term survival. The interplay between chemotherapy and radiotherapy is being meticulously studied to define the optimal sequencing and combination that maximizes tumor control while minimizing toxicity. Furthermore, the integration of targeted therapies and immunotherapy into the perioperative setting is gaining momentum with agents targeting HER2, VEGF, and PD-1/PD-L1, pathways have shown promise in advanced gastric cancer and are now being tested in the neoadjuvant and adjuvant settings. Preliminary results from trials investigating these agents, such as pembrolizumab and trastuzumab-deruxtecan, suggest potential survival benefits and warrant further exploration in combination with chemotherapy in the perioperative context. Additionally, the heterogeneity of gastric cancer across different populations and geographic regions necessitates tailored approaches that consider genetic and molecular characteristics of tumors, as well as patient comorbidities. This Comment provides a comprehensive overview of the latest therapeutic advancements in the perioperative setting for localized gastric cancer, emphasizing the critical role of multimodal treatment approaches.