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Review
. 2025 Jun 7;405(10494):2087-2102.
doi: 10.1016/S0140-6736(25)00052-2. Epub 2025 May 1.

Gastric cancer

Raghav Sundar  1 , Izuma Nakayama  2 , Sheraz R Markar  3 , Kohei Shitara  2 , Hanneke W M van Laarhoven  4 , Yelena Y Janjigian  5 , Elizabeth C Smyth  6
Affiliations
Review

Gastric cancer

Raghav Sundar et al. Lancet. .

Abstract

Gastric cancer remains a major health challenge worldwide, with nearly 1 million new cases annually contributing to more than 650 000 deaths. Epidemiologically, gastric cancer shows substantial geographical variation in incidence, with higher rates in Asia, South America, and eastern Europe, and a rapid increase in early-onset cases among people younger than 50 years. Key risk factors for gastric cancer include Helicobacter pylori infection, diet, obesity, smoking, and genetic predisposition. Early detection through comprehensive diagnostic procedures is crucial for optimising treatment outcomes. Standard treatment approaches for locally advanced gastric cancer include surgical resection, particularly D2 lymphadenectomy, complemented by chemotherapy and radiotherapy. There is increasing implementation of minimally invasive surgical techniques for operable disease and integration of immune checkpoint inhibitors and targeted therapies for advanced stages. Emerging therapies, such as novel targeted treatments and next-generation immunotherapies, show promise in improving survival and quality of life. Future directions in the management of gastric cancer focus on precision medicine, continued advancement in immunotherapy, novel early detection methods, and a multidisciplinary approach to care. These strategies aim to enhance the overall effectiveness of treatment and prognosis worldwide.

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Conflict of interest statement

Declaration of interests ECS reports personal fees from Amgen, Daiichi Sankyo, Merck, Viracta, Astellas, Novartis, Pfizer, Zymeworks, and BeiGene; a grant from Roche; grants and personal fees from BMS and AstraZeneca; consulting fees from Gilead and TCypherBio; advisory board membership with Jazz; and personal fees and non-financial support from Mirati, outside the submitted work. ECS is the chair of the European Organisation for Research and Treatment of Cancer Gastrointestinal Group (2024–27), and has been trustee of the UK and Ireland Oesophagogastric Cancer Group since 2022. ECS is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Oxford. RS reports advisory board roles for Astellas, AstraZeneca, Bayer, BeiGene, Bristol Myers Squibb, Daiichi Sankyo, DKSH, Eisai, GSK, Merck, MSD, Novartis, Pierre-Fabre, Sanofi, Taiho, and Tavotek BioTherapeutics; honoraria for talks from Astellas, AstraZeneca, BeiGene, BMS, Daiichi Sankyo, DKSH, Eli Lilly, Ipsen, MSD, Roche, and Taiho; travel support from AstraZeneca, CytoMed, DKSH, Eisai, Ipsen, Paxman, Roche, and Taiho; research funding from MSD, Natera, and Paxman Coolers; stock ownership with Teladoc; and patents from Paxman Coolers and Auristone, outside the submitted work. RS has patents pending which are licensed to Paxman and in the processing of being licensed to Auristone. HWMvL reports a consultant or advisory role for Amphera, Anocca, Astellas, AstraZeneca, BeiGene, Boehringer, BMS, Daiichi Sankyo, Dragonfly, MSD, Myeloid, and Servier; research funding, medication supply, or other research support from Auristone, Incyte, Merck, ORCA, and Servier; speaker roles for Astellas, AstraZeneca, BeiGene, Benecke, BMS, Daiichi Sankyo, JAAP, Medtalks, Novartis, Springer, and Travel Congress Management; and travel support from AstraZeneca. KS reports receiving personal fees for consulting and advisory roles from Bristol Myers Squibb, Takeda, Ono Pharmaceutical, Novartis, Daiichi Sankyo, Amgen, Boehringer Ingelheim, Merck Pharmaceutical, Astellas, Guardant Health Japan, Janssen, AstraZeneca, Zymeworks, ALX Oncology, Bayer, GlaxoSmithKline, Healios, Moderna, and Arcus Biosciences; receipt of honoraria from Bristol Myers Squibb, Ono Pharmaceutical, Janssen, Eli Lilly, Astellas, and AstraZeneca; and receipt of research funding (all to institution) from Astellas, Ono Pharmaceutical, Daiichi Sankyo, Taiho Pharmaceutical, Chugai, Merck Pharmaceutical, Amgen, Eisai, PRA Health Sciences, Syneos Health, AstraZeneca, PPD-SNBL, and Toray. IN reports receiving honoraria from Bristol Myers Squibb, Ono Pharmaceutical, Astellas, and Merck Pharmaceutical; receiving research funding (all to institution) from Merck Pharmaceutical, Daiichi Sankyo, Chugai Pharma, Ono Pharmaceutical, Astellas, and Boehringer Ingelheim; and travel support from Boehringer Ingelheim. YYJ reports stock and other ownership interests with Inspirna, which is a company without gastric cancer drugs in their current pipeline; stock or stock options with Veeda Life Sciences; honoraria from Astellas Pharma, AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Master Clinician Alliance, Michael J Hennessy Associates, Merck, PeerView, and Research to Practice; consulting or advisory roles for Pfizer, Merck, Bristol Myers Squibb, Merck Serono, Daiichi Sankyo, Rgenix, Bayer, Imugene, AstraZeneca, Zymeworks, Basilea Pharmaceutical, Michael J Hennessy Associates, Seagen, AmerisourceBergen, Arcus Biosciences, BeOne Medicines (formerly BeiGene), Geneos, GlaxoSmithKline, Imedex, Lynx Health, Silverback Therapeutics, AskGene Pharma, Phanes Therapeutics, AbbVie, Astellas Pharma, Gilead Sciences, Guardant Health, Jazz Pharmaceuticals, Boehringer Ingelheim, Clinical Care Options, eChinaHealth, ED Medresources (OncInfo), Eisai, Eli Lilly, H C Wainwright & Co, Inspirna, Master Clinician Alliance, Mersana Therapeutics, Paradigm Medical Communications, PeerMD, PeerView Institute, Physician's Education Resource, Research to Practice, Sanofi Genzyme, Suzhou Liangyihui Network Technology, Talem Health, TotalCME, and WebMD; research funding (all to institution) from Bayer, Rgenix, Bristol Myers Squibb, Merck, Lilly, NCI, Department of Defense, Cycle for Survival, Fred's Team, Genentech/Roche, AstraZeneca, Arcus Biosciences, and Transcenta; travel, accommodation, and expenses from Bristol Myers Squibb Japan and Merck; grants from Astellas, AstraZeneca, Arcus Biosciences, Bayer, Bristol Myers Squibb, Cycle for Survival, Department of Defense, Eli Lilly, Fred's Team, Genentech/Roche, Inspirna, Merck, NCI, Stand Up 2 Cancer, and Transcenta; and other relationships with Clinical Care Options, AXIS Medical Education, and Research to Practice. SRM is supported by the National Institute for Health and Care Research, has advisory roles with Medtronic and Implantica, and has given educational course presentations for BD Phasix and Implantica. SRM is also a trustee for Heartburn Cancer UK.

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