Early stage gastric adenocarcinoma: clinical and molecular landscapes

Gastric adenocarcinoma, even when detected early, remains challenging to treat effectively, leading to low cure rates, especially in Western countries. Challenges include the lack of practical early diagnosis methods, variations in treatment approaches, and the diverse nature of gastric adenocarcinoma cells and their surrounding tumor microenvironment (TME). Clinical trials have historically employed general interventions assuming all early-stage cases are similar, but targeting specific molecular subsets based on genomic and multi-omics analyses, such as microsatellite instability-high, Epstein-Barr virus-induced, DNA damage repair-deficient, HER2-positive, and PD-L1-high subtypes, could improve outcomes. Promising future approaches involve advanced vaccines, novel antibody technologies, agents targeting TME components, and immune checkpoint inhibitors supported by improved diagnostic assays.