Approaches and genetic determinants in predicting response to neoadjuvant chemotherapy in locally advanced gastric cancer

Abstract

Gastric cancer remains a major health burden worldwide. There is near-universal agreement that neoadjuvant chemotherapy (NAC) is a preferred management for locally advanced gastric cancer (LAGC). However, the optimal approach for an individual patient is still not clear and remains controversial, which could be at least partly explained by the lack of predictive tools. The ability to predict chemosensitivity from NAC in routine clinical practice is difficult and is an area of intense investigation, especially in the Precision-Medicine Era. Available consistent evidence suggests that a favorable tumor histopathological response to NAC may be a useful positive prognostic marker in gastric cancer. Hence, it is reasonable to speculate that making the histopathological response from NAC predictable will dramatically facility the NAC and improve patients' outcome. This review provides an overview on the current status of predictive biomarkers for histopathological response from NAC in LAGC, including clinicopathological variables, imaging and molecular testing. Furthermore, limitations and future perspectives are also discussed.

Keywords: chemosensitivity; gastric cancer; histopathological response; neoadjuvant chemotherapy; predictive biomarker.

Figure 1. Summarized theoretic benefits and potential risks of neoadjuvant chemotherapy

Figure 2. The correlation between histopathological response following neoadjuvant chemotherapy and long-term survival

Figure 3. A proposed dynamic model for predicting response from neoadjuvant chemotherapy