Introduction Perioperative chemotherapy remains the standard treatment approach for locally advanced resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma. However, recurrence rates remain high despite curative-intent surgery and systemic therapy, particularly because of peritoneal metastasis.
Introduction
Perioperative chemotherapy remains the standard treatment approach for locally advanced resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma. However, recurrence rates remain high despite curative-intent surgery and systemic therapy, particularly because of peritoneal metastasis. Immune checkpoint inhibitors have demonstrated meaningful survival benefits in advanced gastric cancer, prompting investigation in earlier perioperative settings.
Problem Statement
Although early studies suggested improved pathological response with perioperative immunotherapy, robust long-term survival data in resectable gastric and GEJ cancer remain limited. It is unclear whether addition of PD-1 blockade to perioperative chemotherapy translates into durable event-free and overall survival benefit.
Summary
This 3-year follow-up analysis of the randomized phase II NEOSUMMIT-01 trial demonstrated significant long-term survival benefits with perioperative toripalimab plus oxaliplatin-based chemotherapy in patients with locally advanced gastric or GEJ adenocarcinoma. Compared with chemotherapy alone, the addition of the PD-1 inhibitor toripalimab significantly improved both event-free survival and overall survival, with approximately three-quarters of patients remaining event-free at 3 years. Importantly, the survival benefit persisted even after excluding patients with deficient mismatch repair tumors, indicating efficacy beyond highly immunotherapy-sensitive MSI-H/dMMR disease subsets. The therapeutic advantage was also consistently observed across most predefined clinical subgroups. A particularly notable finding was the marked reduction in peritoneal metastasis, historically one of the most challenging recurrence patterns in gastric cancer. The toripalimab-containing regimen nearly halved overall relapse rates and substantially reduced peritoneal dissemination compared with chemotherapy alone, suggesting improved micrometastatic disease control. The study further strengthens growing evidence supporting oxaliplatin-based chemotherapy backbones as favorable partners for perioperative immunotherapy in gastric cancer. Unlike the negative survival findings observed with perioperative pembrolizumab in KEYNOTE-585, the NEOSUMMIT-01 results align more closely with the positive MATTERHORN trial, collectively supporting integration of immunotherapy into curative-intent treatment paradigms. Although limited by its phase II design and predominantly Asian study population, the trial provides compelling evidence that perioperative toripalimab combined with SOX or CapOx chemotherapy may represent a promising new treatment strategy for resectable locally advanced gastric and GEJ cancers.
Introduction: Circulating tumor DNA (ctDNA) has emerged as a promising noninvasive biomarker for monitoring treatment response and residual disease in solid tumors. However, its prognostic value during neoadjuvant chemotherapy (NAC) for localized pancreatic ductal adenocarcinoma...
Introduction: Aspirin is one of the few interventions proven to reduce colorectal and other Lynch syndrome–associated cancers. The earlier CaPP2 trial established 600 mg daily aspirin as an effective chemopreventive strategy, but concerns regarding long-term...
Introduction: The TOPAZ-1 trial established durvalumab combined with gemcitabine and cisplatin (GemCis) as the first immunotherapy-based first-line standard of care for advanced biliary tract cancer (BTC). However, long-term survival outcomes and durability of benefit beyond...
Introduction: Somatostatin receptor (SSTR) PET/CT has become indispensable for diagnosing, staging, and monitoring neuroendocrine tumors (NETs). However, until now, there has been no standardized method for assessing treatment response using SSTR PET imaging. This international...
Introduction: Staging laparoscopy (SL) is recommended for patients with locally advanced gastric cancer to detect occult peritoneal metastases before curative treatment. However, its real-world utilization across Europe remains uncertain. This large GASTRODATA study evaluated the...
Introduction: Neoadjuvant immune checkpoint inhibitors have transformed the management of mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) locally advanced colorectal cancer, achieving unprecedented pathological response rates. Experimental evidence suggests that cyclooxygenase-2 (COX-2) inhibition may enhance...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.