How Is Stomach Cancer Treated?

Gastric cancer treatment is highly individualized and depends on multiple factors—including tumor stage, location, histologic subtype, molecular characteristics, patient age, overall health, and personal preferences. The cornerstone of curative-intent therapy for localized disease remains surgical resection, typically performed as a gastrectomy (partial or total) with standardized lymph node dissection (D2 lymphadenectomy), which has demonstrated survival benefits in high-volume centers.

For patients with resectable locally advanced gastric cancer, perioperative chemotherapy—most commonly using regimens such as FLOT (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel)—is the current standard of care, supported by robust evidence from randomized trials showing improved progression-free and overall survival compared to surgery alone. In select cases where upfront surgery is not feasible due to tumor burden or comorbidities, neoadjuvant chemoradiotherapy may be considered, though its role remains less established outside specific clinical trial contexts.

Adjuvant therapy following surgery is indicated for patients with pathologic stage II or III disease who did not receive preoperative treatment. Options include capecitabine plus oxaliplatin (XELOX) or S-1 monotherapy (particularly in Asian populations), depending on regional guidelines and tolerability. For metastatic or unresectable disease, systemic therapy forms the mainstay: platinum- and fluoropyrimidine-based doublets are first-line standards, with the addition of trastuzumab for HER2-positive tumors (approximately 15–20% of cases). Emerging biomarker-driven approaches include immune checkpoint inhibitors—such as nivolumab—for PD-L1–positive or microsatellite instability–high (MSI-H) tumors, and claudin 18.2–targeted therapies like zolbetuximab, recently approved in combination with chemotherapy for CLDN18.2-positive, HER2-negative advanced gastric adenocarcinoma.

Palliative interventions—including endoscopic stenting, laser ablation, or radiotherapy—are employed to manage obstructive, bleeding, or painful complications. Multidisciplinary tumor board review is strongly recommended at diagnosis to optimize sequencing of surgery, medical oncology, radiation oncology, and supportive care services. Ongoing clinical trials continue to refine therapeutic strategies, particularly in the domains of immunotherapy combinations, antibody–drug conjugates, and molecularly guided targeted agents.