Perioperative immunotherapy in gastric cancer in the spotlight

Perioperative fluorouracil, leucovorin, oxaliplatin and docetaxel is currently the standard chemotherapy for resectable gastric and gastroesophageal junction adenocarcinomas, based on the results of FLOT4 and ESOPEC trials. This regimen has demonstrated efficacy in tumor downstaging, enhancing the chances of curative resection, and ultimately improving the overall survival. However, despite these advances, the complete response rate in the perioperative setting remains below 10% to 15%, highlighting the need for more effective treatment strategies. Recent studies evaluating immunotherapy, such as the KEYNOTE-585 trial with pembrolizumab and the MATTERHORN trial with durvalumab, have shown promising preliminary results, including improved response rates and event-free survival. Nevertheless, these regimens are not yet considered the standard of care. This article explores the current landscape of perioperative treatments for gastric cancer and discusses future directions in this field.