Multimodality Treatment in Metastatic Gastric Cancer: From Past to Next Future

SIMPLE SUMMARY: Gastric cancer remains an incurable disease in most of the cases. Anyway, the progress achieved over the last decade in terms of knowledge of its biology and available therapeutic options, together with a greater attention to the concept of supportive care, led to a progressive and incremental survival benefit in metastatic gastric cancer patients. In this review we summarize the current standard management and the major completed or ongoing clinical trials involving systemic, surgical or locoregional treatment of metastatic gastric cancer along with emerging concepts likely to improve patients’ outcome in the next future. ABSTRACT: Gastric cancer (GC) still remains an incurable disease in almost two-thirds of the cases. However, a deeper knowledge of its biology in the last few years has revealed potential biomarkers suitable for tailored treatment with targeted agents. This aspect, together with the improvement in early supportive care and a wiser use of the available cytotoxic drugs across multiple lines of treatment, has resulted in incremental and progressive survival benefits. Furthermore, slowly but surely, targeted therapies and immune checkpoint inhibitors are revising the therapeutic scenario even in metastatic GC and especially in particular subgroups. Moreover, important study results regarding the possible role of an integrated approach combining systemic, surgical, and locoregional treatment in carefully selected oligometastatic GC patients are awaited. This review summarizes the state-of-the-art and the major ongoing trials involving a multimodal treatment of metastatic GC.