MODERN PRINCIPLES OF NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED GASTRIC CANCER
Keywords:
Neoadjuvant chemotherapy; gastric cancer; locally advanced tumor; FLOT regimen; ECF regimen; perioperative therapy; targeted therapy; immunotherapy; HER2; PD-1 blockade; precision oncology; tumor downstaging; R0 resection; multidisciplinary management.Abstract
Gastric cancer remains one of the most lethal malignancies worldwide, particularly in cases diagnosed at a locally advanced stage. Despite advances in surgical techniques, the prognosis for such patients remains poor when surgery is used alone. Over the last two decades, neoadjuvant chemotherapy has emerged as a standard component of multimodal treatment, designed to downstage the tumor, improve R0 resection rates, and enhance overall survival.
Modern clinical trials have validated the use of perioperative chemotherapy regimens, such as FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) and ECF (epirubicin, cisplatin, and fluorouracil), as effective strategies for managing locally advanced gastric cancer. These regimens not only facilitate curative resection but also target micrometastatic disease at an early stage. Moreover, the addition of targeted and immunotherapy agents based on molecular profiling—such as HER2 inhibitors and PD-1 blockade—has revolutionized the concept of individualized therapy.
This article discusses the evolution and current principles of neoadjuvant chemotherapy for gastric cancer, focusing on regimen selection, timing, and the role of precision medicine. The review also highlights the importance of multidisciplinary coordination among oncologists, surgeons, and radiologists to optimize patient outcomes and minimize treatment-related toxicity.
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