Chinese consensus on first-line precision therapy for advanced gastric cancer

Gastric cancer (GC) remains a formidable public health challenge in China, characterized by a high incidence and mortality rate. A significant proportion of patients are diagnosed with advanced or metastatic disease, where traditional chemotherapy has historically offered limited survival benefits. However, driven by a deeper molecular understanding of GC heterogeneity, the paradigm of GC treatment is undergoing a revolutionary shift from a "one size fits all" approach toward precision medicine. The identification of predictive biomarkers, such as human epidermal growth factor receptor 2 (HER2/ERBB2; MIM: 164870) expression, microsatellite instability-high (MSI-H) status, PD-L1 (CD274; MIM: 605402) expression, and Claudin 18.2 (CLDN18; MIM: 609210) overexpression, has established biomarker-guided strategies as the unequivocal future direction for managing advanced GC. In particular, the emergence of immune checkpoint inhibitors (ICIs) and agents targeting Claudin 18.2 has revolutionized the landscape of first-line (1L) treatment for GC. China has achieved accelerated breakthroughs in gastric cancer drug research and development, leading to more innovative therapies and improved diagnostic/treatment regimens, providing patients with more abundant and effective treatment options and significantly improving the landscape of diagnosis and treatment. Nevertheless, integrating complex biomarkers and novel agents into practice poses challenges, including inconsistencies in biomarker testing and the need for nuanced treatment regimen selection. Without standardized guidelines, inconsistent application may lead to suboptimal patient outcomes and inefficient use of healthcare resources. This expert consensus has been jointly formulated with the aim of further enhancing and standardizing the biomarker testing and precision medicine of 1L therapy for advanced GC.