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Precision medicine in gastric cancer: where are we now?

ABSTRACT Introduction: Despite advances in surgery, chemotherapy and radiotherapy, the overall prognosis of patients with gastric cancer remains poor. Biology driven targeted treatments could improve outcomes for this devastating disease. Areas covered: The authors review current approaches to the management of gastric cancer. They then focus on predictive biomarker studies that may inform better patient selection for cytotoxic therapy. Emerging evidence suggests that targeting human epidermal growth factor 2 (HER 2), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), mTOR, PARP and immune checkpoint inhibition are exciting new approaches. Expert commentary: The role of biomarkers require further investigation as genetic polymorphisms in addition to the variability in the mRNA and protein expression of rate limiting enzymes could potentially predict potential response or resistance to cytotoxic treatment. Furthermore the utility of functional imaging can play a predictive role in assessing response to neoadjuvant treatment therefore expediting earlier surgical resection in non-responders. The reclassification of gastric cancer by TCGA on molecular and genomic basis lends to the argument to incorporate targeted treatment in everyday clinical management of gastric cancer. Precision medicine has the real potential to prolong survival and improve quality of life in patients with advanced gastric cancer.