Conversion Therapy Approaches in Advanced Gastric Cancer
Summary
Conversion therapy in advanced gastric cancer denotes the strategic use of systemic treatments to shrink tumours initially deemed unresectable, thereby enabling curative surgical intervention. Multimodal regimens combining cytotoxic chemotherapy, molecularly targeted agents and immunotherapy have progressively increased rates of tumour downstaging. Personalised approaches guided by biomarkers such as HER2 status, microsatellite instability and PD-L1 expression inform the choice of trastuzumab, ramucirumab or checkpoint inhibitors in induction protocols. Surgical innovations—from laparoscopic gastrectomy to pressurised intraperitoneal aerosol chemotherapy and hyperthermic intraperitoneal chemotherapy—seek to control peritoneal dissemination and maximise the likelihood of an R0 resection. Meticulous patient selection based on performance status, tumour biology and early treatment response is critical to optimising outcomes. Although long-term survivors remain a minority, emerging data indicate that multidisciplinary conversion strategies can extend median survival beyond two years in selected cohorts, underscoring the global significance of this evolving paradigm.
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Conversion Therapy Approaches in Advanced Gastric Cancer publication trend
The graph below shows the total number of articles in conversion therapy approaches in advanced gastric cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Conversion therapy: Preoperative treatment aimed at converting unresectable tumours into operable disease through tumour shrinkage.
R0 resection: Surgical removal of a tumour with microscopically negative margins, indicating no residual cancer cells.
Immunochemotherapy: Combined use of immune checkpoint inhibitors and cytotoxic chemotherapy to enhance anti-tumour efficacy.
Peritoneal metastasis: Dissemination of gastric cancer cells onto the peritoneal surfaces, often requiring intraperitoneal treatment strategies.
Hyperthermic intraperitoneal chemotherapy (HIPEC): Administration of heated chemotherapy within the abdominal cavity during surgery to eradicate microscopic peritoneal disease.
Downstaging: Reduction in clinical or pathological tumour stage following preoperative therapy, increasing the potential for curative resection.
References
- Low Expectancy of Conversion Surgery with R0 Resection in Patients with CEA > 5.0 ng/mL at the Initial RECIST Evaluation for Metastatic Gastric Cancer. Cancers (2023).
- Clinical outcomes of conversion surgery following immune checkpoint inhibitors and chemotherapy in stage IV gastric cancer. International Journal of Surgery (2023).
- The Clinical Implication of Conversion Surgery in Patients with Stage IV Gastric Cancer Who Received Systemic Chemotherapy. Biomedicines (2023).
- A comprehensive overview of gastric cancer management from a surgical point of view. Biomedical Journal (2024).
- The long-term survival of stage IV gastric cancer patients with conversion therapy. Gastric Cancer (2017).
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