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Advances in molecularly targeted agents and immune checkpoint inhibitors have renewed clinical and research interest, particularly for metastatic gastric cancer. This review synthesizes international guidelines and expert consensus, highlighting systemic therapy’s central role, biomarker-driven strategies, and optimal surgical timing, including consensus meetings and key trials across cytotoxic, targeted, and immunotherapy eras.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/from-control-to-conversion-optimizing-systemic-therapy-for-curative-intent-conversion-surgery-in-metastatic-gastric-cancer/350885/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/from-control-to-conversion-optimizing-systemic-therapy-for-curative-intent-conversion-surgery-in-metastatic-gastric-cancer/350885.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-23","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the core purpose of conversion therapy in metastatic gastric cancer?","Question",{"text":112,"@type":113},"Conversion therapy bridges palliative systemic treatment toward curative-intent local therapy by enabling complete (R0) resection and reducing relapse-driving micrometastatic disease.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why has interest in conversion therapy increased recently?",{"text":117,"@type":113},"Recent advances in systemic therapy, including molecular targeted agents and immune checkpoint inhibitors, have renewed both clinical practice and research focus on this strategy.",{"name":119,"@type":110,"acceptedAnswer":120},"Is conversion surgery currently standard of care for metastatic gastric cancer?",{"text":121,"@type":113},"Conversion surgery is not yet universally standard of care according to global guidelines, but it may be considered for biologically and clinically selected patients who show major response to systemic therapy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},350885,1790131119,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","J Gastric Cancer. 2026 Jan;26(1):146-160 [https://doi.org/10.5230/jgc.2026.26.e8](https://doi.org/10.5230/jgc.2026.26.e8)[ ](https://doi.org/10.5230/jgc.2026.26.e8)pISSN 2093-582X·eISSN 2093-5641  \nReview Article  \nReceived: Dec 17, 2025  \nAccepted: Dec 18, 2025  \nPublished online: Dec 30, 2025  \nCorrespondence to  \nSun Young Rha  \nDivision of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Email: [RHA7655@yuhs.ac](RHA7655@yuhs.ac)  \nCopyright © 2026. Korean Gastric Cancer Association  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0](creativecommons.org/licenses/by-nc/4.0)) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.  \nORCID iDs  \nHye Sook Han  [https://orcid.org/0000-0001-6729-8700](https://orcid.org/0000-0001-6729-8700)[ ](https://orcid.org/0000-0001-6729-8700)Sun Young Rha  [https://orcid.org/0000-0002-2512-4531](https://orcid.org/0000-0002-2512-4531)  \nConflict of Interest  \nNo potential conflict of interest relevant to this article was reported.  \nAuthor Contributions  \nConceptualization: H. H.S., R.S.Y.; Data  \ncuration: H. H.S.; Formal analysis: H. H.S.,  \nR.S.Y.; Funding acquisition: R.S.Y.; Investigation: H. H.S., R.S.Y.; Methodology:  \nH. H.S., R.S.Y.; Project administration: H. H.S.,  \nR.S.Y.; Resources: H. H.S., R.S.Y.; Software:  \nH. H.S., R.S.Y.; Supervision: R.S.Y.; Validation:  \nR.S.Y.; Visualization: H. H.S.; Writing-original draft: H. H.S.  \nFrom Control to Conversion: Optimizing Systemic Therapy for Curative-Intent Conversion Surgery in Metastatic Gastric Cancer  \nHye Sook Han  1, Sun Young Rha  2,3,4  \n1Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea  \n2Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea  \n3Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea  \n4Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea  \nABSTRACT  \nConversion therapy enables curative-intent resection in patients with initially unresectable or metastatic cancers after effective systemic therapy. Recently, advances in systemic therapy with molecular targeted agents and immune checkpoint inhibitors (ICIs) have renewed clinical and research interest in this approach, particularly for metastatic gastric cancer (GC). This review aimed to summarize the international guidelines and expert consensus informed by contemporary evidence on conversion therapy for metastatic GC, emphasizing the central role of systemic therapy, the emergence of biomarker-driven strategies, and the optimal timing for surgical intervention. Key consensus statements (Bertinoro, OMEC, and KINGCA WEEK 2024) and pivotal studies covering the cytotoxic, targeted, and immunotherapy eras were reviewed, focusing on regimen selection, treatment duration, and prognostic determinants associated with surgical outcomes. According to global guidelines, conversion surgery is not yet standard of care but may be considered for biologically and clinically selected patients demonstrating a major response to systemic therapy. Retrospective and prospective studies have reported a median overall survival of 24–36 months in the cytotoxic era and >48 months in the ICI/targeted era among patients who underwent R0 resection. Emerging evidence supports approximately 6 months of preoperative systemic therapy, followed by R0 resection, and up to one year of postoperative maintenance therapy. Therefore, conversion surgery should be viewed as the culmination of effective systemic therapy r","cbCaiog2hxLtOAHO","https://ap.wps.com/l/cbCaiog2hxLtOAHO","pdf",1321428,15,"English","# Conversion Therapy in Gastric Cancer\n## Concept of conversion surgery for metastatic gastric cancer\n## Conversion therapy across palliative and curative intent","[{\"question\":\"What is the core purpose of conversion therapy in metastatic gastric cancer?\",\"answer\":\"Conversion therapy bridges palliative systemic treatment toward curative-intent local therapy by enabling complete (R0) resection and reducing relapse-driving micrometastatic disease.\"},{\"question\":\"Why has interest in conversion therapy increased recently?\",\"answer\":\"Recent advances in systemic therapy, including molecular targeted agents and immune checkpoint inhibitors, have renewed both clinical practice and research focus on this strategy.\"},{\"question\":\"Is conversion surgery currently standard of care for metastatic gastric cancer?\",\"answer\":\"Conversion surgery is not yet universally standard of care according to global guidelines, but it may be considered for biologically and clinically selected patients who show major response to systemic therapy.\"}]","From Control to Conversion: Optimizing Systemic Therapy for Curative-Intent Conversion Surgery in Metastatic Gastric Cancer | PDF",1790091652,38]