East meets west: resectable gastric cancer treatment in the era of immune checkpoint inhibitors

INTRODUCTION: Resectable gastric cancer remains a major global health challenge, with significant geographic variation in treatment paradigms between Eastern and Western practice. While perioperative chemotherapy has been established as the standard of care in the West, Eastern strategies have traditionally favored upfront surgery followed by adjuvant therapy. The emergence of immune checkpoint inhibitors (ICIs) is reshaping this landscape, raising critical questions regarding optimal integration into curative-intent treatment. AREAS COVERED: This review examines contemporary evidence underpinning Eastern and Western approaches to resectable gastric cancer, including perioperative chemotherapy, adjuvant strategies, and surgical standards. Key publications, including phase II-III trials, meta-analyses, and recent guideline updates, were reviewed. EXPERT OPINION: The integration of ICIs into curative-intent treatment represents a paradigm shift in the management of resectable gastric cancer, but its clinical impact is strongly influenced by regional practice patterns. Recent phase III data support the use of perioperative chemo-immunotherapy in Western treatment paradigms, whereas benefits may be more limited in Eastern settings where outcomes with surgery and adjuvant chemotherapy are already favorable for earlier stage gastric cancer. Future progress will depend on refining patient selection, optimizing sequencing, and incorporating biomarker- and response-adapted strategies.