Evolution of Gastric Cancer Treatment: From the Golden Age of Surgery to an Era of Precision Medicine

Gastric cancer imposes a global health burden. Although multimodal therapies have proven to benefit patients with advanced diseases after curative surgery, the prognosis of most advanced cancer patients still needs to be improved. Surgical extirpation is the mainstay of gastric cancer treatment. Indeed, without curative surgery, variations and combinations of chemotherapy and/or radiation cannot bring clinically meaningful success. Centered around D2 surgery, adjuvant and peri-operative multimodal ther-apies have improved survival in a certain group of gastric cancer patients. Moving toward a personalized cancer therapy era, mo-lecular targeted strategies have been tested in clinical trials for gastric cancer. With some success and failures, we have learned valuable lessons regarding the biology of gastric cancer and the clinical relevance of biological therapies in addition to conven-tional treatments. Future treatment of gastric cancer will be shifted to molecularly tailored and genome information-based per-sonalized therapy. Collaboration across disciplines and actively adopting emerging anti-cancer strategies, along with in-depth understanding of molecular and genetic underpinnings of tumor development and progression, are imperative to realizing per-sonalized therapy for gastric cancer. Although many challenges remain to be overcome, we envision that the era of precision can-cer medicine for gastric cancer has already arrived and anticipate that current knowledge and discoveries will be transforme