Immunotherapy in Advanced Gastric Cancer: Advancing Precision Medicine and Emerging Therapeutic Strategies

Abstract

Advanced gastric cancer (GC) continues to pose a substantial global health burden, with traditional treatment modalities providing only modest clinical benefit. In recent years, immunotherapy has emerged as a transformative strategy, and immune checkpoint inhibitors (ICIs) have revolutionized the treatment of numerous cancers, including hematologic malignancies, melanoma, and lung cancer. Clinical studies have established that immunotherapy also improves survival in advanced GC, yet critical issues remain regarding the identification of optimal candidates, the clarification of efficacy for monotherapy or combination strategies, and the exploration of potential biomarkers for immunotherapy. This review delineates therapeutic strategies involving ICIs for advanced GC, including single-agent, combination therapy, and dual-ICI approaches. The review also provides a critical appraisal of the utility of biomarkers for predicting therapeutic response, a summary of the current state of CAR-T cell therapy, and an overview of ongoing investigations into cancer vaccines. A strategic framework for the selection of immunotherapy in advanced GC is also proposed. Precision-based strategies have potential in enhancing treatment efficacy and reducing the financial burden of the patient. Despite the paradigm shift brought by immunotherapy in advanced GC, immune-related adverse events (irAEs) remain a significant clinical hurdle. A detailed discussion of these events is beyond the scope of this review due to space constraints.