Abstract:

Gastric cancer presents a high incidence rate and substantial disease burden, posing significant therapeutic challenges. Recent advances have yielded significant benefits for gastric cancer patients through novel anti-tumor agents, including immune checkpoint inhibitor (ICI), human epidermal growth factor receptor 2 (HER2)-targeted therapies, and claudin 18.2 (CLDN18.2)-directed agents. Both monotherapy and various combination regimens demonstrate considerable promise in gastric cancer treatment. However, a critical safety concern potentially limiting patient benefit is drug-induced interstitial lung disease (ILD)/pneumonitis, particularly associated with ICI and antibody-drug conjugate (ADC). The risk and underlying mechanisms of ILD vary considerably across different anti-tumor drug classes, and its often insidious onset makes early detection difficult. Therefore, a deep understanding of the distinct ILD risks and mechanisms associated with different agents, coupled with rational, individualized drug monitoring and patient management, is paramount. This review systematically analyzes the incidence rates, clinical characteristics, and risk factors associated with ILD/pneumonitis reported in recent clinical trials of anti-tumor therapies for gastric cancer. It aimed to elucidate the risk stratification and mechanistic differences between drug classes, thereby enhancing clinical awareness and ultimately helping to maximize clinical outcomes for gastric cancer patients.

Key words: Gastric cancer, Anticancer drug, Interstitial lung disease, Pneumonitis, Progress