Revolutionizing gastric cancer treatment: The potential of immunotherapy

Abstract

Gastric cancer, a prevalent malignancy worldwide, ranks sixth in terms of frequency and third in fatality, causing over a million new cases and 769000 annual deaths. Predominant in Eastern Europe and Eastern Asia, risk factors include family medical history, dietary habits, tobacco use, Helicobacter pylori, and Epstein-Barr virus infections. Unfortunately, gastric cancer is often diagnosed at an advanced stage, leading to a grim prognosis, with a 5-year overall survival rate below 5%. Surgical intervention, particularly with D2 Lymphadenectomy, is the mainstay for early-stage cases but offers limited success. For advanced cases, the National Comprehensive Cancer Network recommends chemotherapy, radiation, and targeted therapy. Emerging immunotherapy presents promise, especially for unresectable or metastatic cases, with strategies like immune checkpoint inhi-bitors, tumor vaccines, adoptive immunotherapy, and nonspecific immunomodulators. In this Editorial, with regards to the article “Advances and key focus areas in gastric cancer immunotherapy: A comprehensive scientometric and clinical trial review”, we address the advances in the field of immunotherapy in gastric cancer and its future prospects.

Keywords: Immunotherapy; Adaptive immunotherapy; Tumor vaccines; Chimeric antigen receptor therapy; Tumor-infiltrating lymphocytes therapy; Natural killer therapy; Cytokine-induced killer therapy; Engineered T cell receptor therapy; Immune checkpoint inhibitors

Core Tip: Immunotherapy, especially immune checkpoint inhibitors (ICIs), has revolutionized cancer treatment by targeting programmed cell death 1, programmed cell death ligand 1 (PD-L1), and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), enhancing the immune response. While PD-L1 and CTLA-4's prognostic significance in gastric cancer remains debatable, ICIs like nivolumab and pembrolizumab show promise. Tailored approaches, such as zolbetuximab for CLDN 18.2 or trastuzumab, pembrolizumab, and chemotherapy for human epidermal growth factor receptor 2-positive cases, demonstrate effectiveness. Tumor vaccines and dendritic cell-based vaccines hold potential in personalized therapy. Adoptive Immunotherapy utilizes tumor-infiltrating lymphocytes therapy, engineered T cell receptor therapy, Chimeric antigen receptor T-cell therapy, natural killer cell therapy, and cytokine-induced killer cell therapy, each with distinct benefits and challenges. The immunotherapy landscape continues to evolve, offering hope for improved cancer management.