Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

TLDR

Gastric cancer, the third leading cause of cancer‑related deaths worldwide, is predominantly adenocarcinoma, often diagnosed late, and has poor prognosis, and systemic therapy and biomarker‑guided targeted treatments such as HER2, MSI, and PD‑L1 testing have improved outcomes, while multidisciplinary palliative care remains essential. This NCCN guideline excerpt addresses the management of unresectable locally advanced, recurrent, or metastatic gastric cancer.

Abstract

Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability (MSI) status, and the expression of programmed death-ligand 1 (PD-L1), has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with localized gastric cancer. This selection from the NCCN Guidelines for Gastric Cancer focuses on the management of unresectable locally advanced, recurrent, or metastatic disease.