Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO

Yu LAN; Fenghua WANG

doi:10.19401/j.cnki.1007-3639.2025.02.009

您当前的位置：

首页 >

文章列表页 >

Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO

Specialist's Commentary | 更新时间：2025-12-31

- Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO
- China Oncology Vol. 35, Issue 2, Pages: 219-227(2025)
- 作者机构：
  
  中山大学肿瘤防治中心肿瘤内科，广东广州 510000
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2025.02.009
  CLC：
- Received：07 January 2025，
  
  Revised：2025-02-10，
  
  Published：28 February 2025
- 稿件说明：
移动端阅览
Yu LAN, Fenghua WANG. Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO[J]. China Oncology, 2025, 35(2): 219-227.
DOI：

Yu LAN, Fenghua WANG. Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO[J]. China Oncology, 2025, 35(2): 219-227. DOI： 10.19401/j.cnki.1007-3639.2025.02.009.

摘要

胃癌是全球范围内高发恶性肿瘤，具有高度侵袭性，总体预后不佳等特点。东西方胃癌人群在流行病学、临床病理学特征、治疗模式及药物选择等方面存在差异。近年来，随着靶向治疗和免疫治疗的快速推进，精准治疗理念的成熟和多学科治疗的推广等，临床研究成果不断更新，胃癌指南每年持续更新，以适应不断变化的诊疗需求。本文就全球范围内三大权威胃癌指南最新版[包括美国国家综合癌症网络（National Comprehensive Cancer Network，NCCN）胃癌临床实践指南2024年V5版（2024年12月发布）、欧洲肿瘤内科学会（European Society for Medical Oncology，ESMO）胃癌在线指南2024版（2024年9月发布）和中国临床肿瘤协会（Chinese Society of Clinical Oncology，CSCO）胃癌诊疗指南（2024年4月发布）]更新内容的异同点进行对比与梳理，聚焦不可手术切除的局部晚期或转移性食管胃结合部和胃腺癌的临床治疗策略，关注基于靶点如人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）、程序性死亡受体配体1（programmed death-ligand 1，PD-L1）表达、错配修复蛋白（mismatch repair，MMR）状态和新靶点如Claudin 18.2（CLDN18.2）等为导向的抗肿瘤药物的精准实施和全程管理。其中，HER2阳性晚期胃癌进入全线抗HER2治疗时代，抗HER2的抗体药物偶联物（antibody-drug conjugate，ADC）成为一线曲妥珠单抗治疗耐药之后的新选择。除此之外，免疫治疗联合化疗成为晚期胃癌一线治疗新标准，基于MMR状态和PD-L1表达指导的诊疗模式将免疫治疗推向精准化，然而目前PD-L1表达检测在临床推广和执行的过程中仍存在一定困难。2024年发表的三大指南融合了最新的临床研究结果、药物适应证的获批情况和医疗保健系统的实情等内容，尤其是CSCO胃癌指南基于中国自主研发药物的快速发展和针对中国人群研究适应证的成功获批进行了更新。三大指南在靶向治疗、免疫疗法等新疗法的推荐和采用等方面存在差异，本文基于不同指南内容展现出不同的视角与侧重，以丰富临床决策的维度，增强循证医学指南的临床适应性，进而指导临床实践。

Abstract

Gastric cancer is a highly prevalent and aggressive malignancy worldwide

with generally poor prognosis. There are differences in epidemiology

clinicopathological characteristics

treatment modalities

and drug selection for gastric cancer between Eastern and Western populations. Recent advancements in targeted therapy and immunotherapy

the maturation of precision treatment concepts

and the promotion of multidisciplinary therapy have led to continuous updates in clinical research outcomes. Gastric cancer guidelines are annually updated to meet evolving diagnostic and therapeutic needs. This article compared the latest versions of three authoritative global gastric cancer guidelines [National Comprehensive Cancer Network (NCCN) clinical practice guidelines for gastric cancer 2024 version 5

European Society for Medical Oncology (ESMO) online guidelines for gastric cancer 2024

and Chinese Society of Clinical Oncology (CSCO) guidelines for gastric cancer diagnosis and treatment 2024]

focusing on clinical treatment strategies for unresectable locally advanced or metastatic esophagogastric junction/gastric adenocarcinoma

and on the whole-process management and precise implementation guided by targets such as human epidermal growth factor receptor 2 (HER2) expression

programmed cell death ligand 1 (PD-L1) expression

mismatch repair (MMR) status

and novel targets such as Claudin 18.2. Meanwhile

HER2-positive advanced gastric cancer has entered the era of full-line anti-HER2 treatment. Anti-HER2 antibody-drug conjugates (ADCs) has become a new option after first-line trastuzumab resistance. Immunotherapy combined with chemotherapy is regarded as a new standard for the first-line treatment of advanced gastric cancer. The diagnosis and treatment mode based on MMR status and PD-L1 expression promote the precision of immunotherapy. However

the detection of PD-L1 expression has difficulties in clinical promotion and implementation. The three guidelines in 2024 integrate the latest clinical study results

the new indication approval and the updated health care system. In particular

the CSCO gastric cancer guidelines are rewritten based on the rapid development of independently developed drugs in China and the approval of new indications. The three guidelines differ in the recommendation and adoption of targeted therapy and immunotherapy. This article showed different perspectives and focuses based on different guidelines

enriched the dimensions of clinical decision-making

helped the clinical adaptability of evidence-based guidelines to better enlightens clinical practice.

关键词

Keywords

references

BRAY F , LAVERSANNE M , SUNG H , et al . Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J ] . CA Cancer J Clin , 2024 , 74 ( 3 ): 229 - 263 .

HAN B F , ZHENG R S , ZENG H M , et al . Cancer incidence and mortality in China, 2022 [J ] . J Natl Cancer Cent , 2024 , 4 ( 1 ): 47 - 53 .

JANJIGIAN Y Y , KAWAZOE A , BAI Y X , et al . Pembrolizumab plus trastuzumab and chemotherapy for HER2-positive gastric or gastro-oesophageal junction adenocarcinoma: interim analyses from the phase 3 KEYNOTE-811 randomised placebo-controlled trial [J ] . Lancet , 2023 , 402 ( 10418 ): 2197 - 2208 . DOI: 10.1016/S0140-6736(23)02033-0 http://doi.org/10.1016/S0140-6736(23)02033-0

RHA S Y , KAWAZOE A , BAI Y , et al . Final overall survival for the phase Ⅲ, KEYNOTE-811 study of pembrolizumab plus trastuzumab and chemotherapy for HER2 + advanced, unresectable or metastatic G/GEJ adenocarcinoma [J ] . Ann Oncol , 2024 , 35 : S1453-S1454.

JANJIGIAN Y Y , SHITARA K , MOEHLER M , et al . First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial [J ] . Lancet , 2021 , 398 ( 10294 ): 27 - 40 . DOI: 10.1016/S0140-6736(21)00797-2 http://doi.org/10.1016/S0140-6736(21)00797-2

RHA S Y , OH D Y , YAÑEZ P , et al . Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for HER2-negative advanced gastric cancer (KEYNOTE-859): a multicentre, randomised, double-blind, phase 3 trial [J ] . Lancet Oncol , 2023 , 24 ( 11 ): 1181 - 1195 . DOI: 10.1016/S1470-2045(23)00515-6 http://doi.org/10.1016/S1470-2045(23)00515-6

KANG Y K , CHEN L T , RYU M H , et al . Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (ATTRACTION-4): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial [J ] . Lancet Oncol , 2022 , 23 ( 2 ): 234 - 247 .

XU J M , JIANG H P , PAN Y Y , et al . Sintilimab plus chemotherapy for unresectable gastric or gastroesophageal junction cancer: the ORIENT-16 randomized clinical trial [J ] . JAMA , 2023 , 330 ( 21 ): 2064 - 2074 . DOI: 10.1001/jama.2023.19918 http://doi.org/10.1001/jama.2023.19918

QIU M Z , OH D Y , KATO K , et al . Tislelizumab plus chemotherapy versus placebo plus chemotherapy as first line treatment for advanced gastric or gastro-oesophageal junction adenocarcinoma: RATIONALE-305 randomised, double blind, phase 3 trial [J ] . BMJ , 2024 , 385 : e078876 .

ZHANG X , WANG J , WANG G , et al . Prespecified progression-free survival (PFS) and overall survival (OS) final analyses of a phase Ⅲ study of sugemalimab plus chemotherapy vs placebo plus chemotherapy in treatment-naïve advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma [J ] . Ann Oncol , 2023 , 34 : S1319 .

JI J F , ZIYU LI , ZHANG X T , GAO X Y , et al . Cadonilimab plus chemotherapy versus chemotherapy as first-line treatment for unresectable locally advanced or metastatic gastric or gastroesophageal junction (G/GEJ) adenocarcinoma (COMPASSION-15): a randomized, double-blind, phase 3 trial [C ] . AACR , 2024 .

SHITARA K , VAN CUTSEM E , BANG Y J , et al . Efficacy and safety of pembrolizumab or pembrolizumab plus chemotherapy vs chemotherapy alone for patients with first-line, advanced gastric cancer: the KEYNOTE-062 phase 3 randomized clinical trial [J ] . JAMA Oncol , 2020 , 6 ( 10 ): 1571 - 1580 .

WANG Y K , WANG C , CHEN X F , et al . Camrelizumab plus apatinib and SOX as first-line treatment in patients with alpha-fetoprotein-producing gastric or gastroesophageal junction adenocarcinoma: a single-arm, multi-center, phase 2 trial [J ] . J Clin Oncol , 2024 , 42 ( 3_suppl ): 351 .

SHITARA K , LORDICK F , BANG Y J , et al . Zolbetuximab plus mFOLFOX6 in patients with CLDN18.2-positive, HER2-negative, untreated, locally advanced unresectable or metastatic gastric or gastro-oesophageal junction adenocarcinoma (SPOTLIGHT): a multicentre, randomised, double-blind, phase 3 trial [J ] . Lancet , 2023 , 401 ( 10389 ): 1655 - 1668 . DOI: 10.1016/S0140-6736(23)00620-7 http://doi.org/10.1016/S0140-6736(23)00620-7

SHAH M A , SHITARA K , AJANI J A , et al . Zolbetuximab plus CAPOX in CLDN18.2-positive gastric or gastroesophageal junction adenocarcinoma: the randomized, phase 3 GLOW trial [J ] . Nat Med , 2023 , 29 ( 8 ): 2133 - 2141 . DOI: 10.1038/s41591-023-02465-7 http://doi.org/10.1038/s41591-023-02465-7

SHITARA K , BANG Y J , IWASA S , et al . Trastuzumab deruxtecan in HER2-positive advanced gastric cancer: exploratory biomarker analysis of the randomized, phase 2 DESTINY-Gastric01 trial [J ] . Nat Med , 2024 , 30 ( 7 ): 1933 - 1942 . DOI: 10.1038/s41591-024-02992-x http://doi.org/10.1038/s41591-024-02992-x

VAN CUTSEM E , DI BARTOLOMEO M , SMYTH E , et al . Trastuzumab deruxtecan in patients in the USA and Europe with HER2-positive advanced gastric or gastroesophageal junction cancer with disease progression on or after a trastuzumab-containing regimen (DESTINY-Gastric02): primary and updated analyses from a single-arm, phase 2 study [J ] . Lancet Oncol , 2023 , 24 ( 7 ): 744 - 756 . DOI: 10.1016/S1470-2045(23)00215-2 http://doi.org/10.1016/S1470-2045(23)00215-2

THUSS-PATIENCE P C , SHAH M A , OHTSU A , et al . Trastuzumab emtansine versus taxane use for previously treated HER2-positive locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma (GATSBY): an international randomised, open-label, adaptive, phase 2/3 study [J ] . Lancet Oncol , 2017 , 18 ( 5 ): 640 - 653 .

PENG Z , LIU T S , WEI J , et al . Efficacy and safety of a novel anti-HER2 therapeutic antibody RC48 in patients with HER2-overexpressing, locally advanced or metastatic gastric or gastroesophageal junction cancer: a single-arm phase Ⅱ study [J ] . Cancer Commun (Lond) , 2021 , 41 ( 11 ): 1173 - 1182 .

SHEN L , CHEN P , LU J , et al . Trastuzumab deruxtecan (T-DXd) in Chinese patients (pts) with previously treated HER2-positive locally advanced/metastatic gastric cancer (GC) or gastroesophageal junction adenocarcinoma (GEJA): primary efficacy and safety from the phase Ⅱ single-arm DESTINY-Gastric06 (DG06) trial [J ] . Ann Oncol , 2023 , 34 : S1542-S1543.

SHEN L , LI J , DENG Y H , et al . Envafolimab (KN035) in advanced tumors with mismatch-repair deficiency [J ] . J Clin Oncol , 2020 , 38 ( 15_suppl ): 3021 .

LI J , XU Y , ZANG A M , et al . A phase 2 study of tislelizumab monotherapy in patients with previously treated, locally advanced unresectable ormetastatic microsatellite instability-high/mismatch repair deficient solid tumors [J ] . J Clin Oncol , 2021 , 39 ( 15_suppl ): 2569 .

QIN S , LI J , ZHONG H , et al . Efficacy and safety of HLX10, a novel anti-PD-1 antibody, in patients with previously treated unresectable or metastatic microsatellite instability-high or mismatch repair-deficient solid tumors: a single-arm, multicenter, phase 2 study [J ] . J Clin Oncol , 2022 .

FUCHS C S , TOMASEK J , YONG C J , et al . Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial [J ] . Lancet , 2014 , 383 ( 9911 ): 31 - 39 . DOI: S0140-6736(13)61719-5 http://doi.org/S0140-6736(13)61719-5

XU R H , WANG F , SHEN L , et al . Fruquintinib plus paclitaxel versus paclitaxel as second-line therapy for patients with advanced gastric or gastroesophageal junction adenocarcinoma (FRUTIGA): a randomized, multicenter, double-blind, placebo-controlled, phase 3 study [J ] . J Clin Oncol , 2024 , 42 ( 36_suppl ): 438780 .

LI J , QIN S K , XU J M , et al . Randomized, double-blind, placebo-controlled phase Ⅲ trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction [J ] . J Clin Oncol , 2016 , 34 ( 13 ): 1448 - 1454 .

Views

3297

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

A study on the immunomicroenvironment characteristics of gastric cancer with neuroendocrine neoplasm and pure gastric cancer

Prospective trial on impact of oral nutritional supplements on elderly patients with nutritional risk after radical surgery for gastric cancer

Research progress and future perspectives of anticancer drug-induced interstitial lung disease/pneumonia in gastric cancer

Discovery and preliminary validation of five early gastric cancer biomarkers, including TAGLN2 and CTSD, based on serum proteomics

Artificial intelligence in gastric cancer diagnosis, treatment and prognostic prediction: current application and future perspective

Related Author

ZHANG Yi

SUN Haidong

QU Xinglong

ZHAO Bin

Qiulei XI

Xinyi WANG

Shanjun TAN

Zhige ZHANG

Related Institution

Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Department of Surgical Oncology, Minhang Branch, Fudan University Shanghai Cancer Center

Department of Gastrointestinal Surgery, General Surgery, Zhongshan Hospital, Fudan University

Department of Clinical Nutrition, Zhongshan Hospital, Fudan University

Department of Medical Oncology, The First Hospital of China Medical University

AI问答

⁰