Two Onc Docs Gastric Cancer 2025 UPDATE
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Aug 19, 2025 This week dives deep into gastric adenocarcinoma, discussing risk factors like H. pylori infections and the importance of genetic testing. The latest staging techniques, including EGD and biopsies, are detailed for managing advanced cases. Advances in treatment are highlighted, with a focus on the newly approved zolbituximab for metastatic cases. The use of immunotherapy for specific genetic profiles is also explored, alongside ongoing clinical trial impacts and future directions in gastric cancer care.
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Thorough Initial Diagnostic Workup
- Do work up new gastric adenocarcinoma with EGD+EUS and biopsy, CT chest/abdomen/pelvis with oral and IV contrast, and laparoscopy with cytology when considering surgery or chemoradiation.
- Consider PET if CT is negative because about 10% of metastases can be missed on CT scans.
Mandatory Molecular Testing At Diagnosis
- Send MSI testing (PCR or NGS) and mismatch repair IHC on every new gastric adenocarcinoma at diagnosis.
- Also test HER2 and PD-L1 for metastatic cases and add CLDN18.2 testing for advanced disease.
Perioperative FLOT Is Preferred For T2+
- For T2+ or node-positive locally advanced gastric cancer, perioperative chemotherapy is preferred over upfront surgery.
- FLOT (4 cycles pre- and post-op) is the current category 1 standard per FLOT4 trial.