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Landmark phase III trials, including PRODIGY and RESOLVE, support neoadjuvant chemotherapy as a viable option, particularly in Asia, while the MATTERHORN trial explores perioperative immune checkpoint inhibitors. The review also evaluates Asian use of fluorouracil, leucovorin, oxaliplatin, and docetaxel in light of regional standards and toxicity concerns such as neutropenia. It highlights key issues: response assessment, limits of pathological response as a surrogate endpoint, biomarker-driven patient selection, and how long postoperative therapy should continue. It emphasizes personalization using clinical stage, pathological response, and circulating tumor DNA.",{"@graph":69,"@context":123},[70,84,106],{"@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/neoadjuvant-chemotherapy-for-gastric-cancer-evolving-approaches-and-supporting-evidence/358340/",{"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/neoadjuvant-chemotherapy-for-gastric-cancer-evolving-approaches-and-supporting-evidence/358340.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main clinical role of neoadjuvant therapy in locally advanced gastric cancer?","Question",{"text":113,"@type":114},"Neoadjuvant therapy is presented as a promising strategy to improve outcomes and treatment compliance by enabling earlier chemotherapy delivery at relatively high dose intensity.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which major trials are highlighted for neoadjuvant chemotherapy and perioperative approaches?",{"text":118,"@type":114},"The review cites phase III PRODIGY and RESOLVE for establishing neoadjuvant chemotherapy as a viable option, and MATTERHORN for the potential integration of immune checkpoint inhibitors into perioperative treatment.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is chemotherapy regimen selection cautioned in Asian populations?",{"text":122,"@type":114},"The review emphasizes careful consideration of fluorouracil, leucovorin, oxaliplatin, and docetaxel use due to regional treatment standards and concerns about chemotherapy-related toxicities, including neutropenia.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},358340,1790216061,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146},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):106-126 [https://doi.org/10.5230/jgc.2026.26.e2](https://doi.org/10.5230/jgc.2026.26.e2)[ ](https://doi.org/10.5230/jgc.2026.26.e2)pISSN 2093-582X·eISSN 2093-5641  \nReview Article  \nReceived: Sep 20, 2025  \nRevised: Nov 21, 2025  \nAccepted: Nov 21, 2025  \nPublished online: Dec 18, 2025  \nCorrespondence to  \nHyung-Don Kim  \nDepartment of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.  \nEmail: [kimhdmd@amc.seoul.kr](kimhdmd@amc.seoul.kr)  \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  \nHyung-Don Kim  [https://orcid.org/0000-0001-9959-0642](https://orcid.org/0000-0001-9959-0642)[ ](https://orcid.org/0000-0001-9959-0642)[Min-Hee Ryu](Min-Hee Ryu)  [https://orcid.org/0000-0002-1033-1263](https://orcid.org/0000-0002-1033-1263)  \nConflict of Interest  \nNone directly related to this work. Outside of this study, MHR received honoraria from DAEHWA Pharmaceutical, Bristol Myers Squibb, Lilly, Ono Pharmaceutical, MSD, Taiho Pharmaceutical, Novartis, Daiichi Sankyo, and AstraZeneca, and served as a consultant for DAEHWA Pharmaceutical, Bristol Myers Squibb, Lilly, and Ono Pharmaceutical.  \nHDK received research grants from Roche/ Genentech, Amgen, and AstraZeneca, as  \nNeoadjuvant Chemotherapy for Gastric Cancer: Evolving Approaches and Supporting Evidence  \nYoung Jae Kim, Hyung-Don Kim , Jaewon Hyung, Min-Hee Ryu   \nDepartment of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea  \nABSTRACT  \nNeoadjuvant and perioperative therapy have emerged as promising strategies for managing locally advanced gastric cancer (LAGC). Landmark phase III studies, such as PRODIGY and RESOLVE, have established neoadjuvant chemotherapy as a viable therapeutic option in Asia. More recently, the MATTERHORN trial demonstrated the potential of incorporating immune checkpoint inhibitors (ICIs) into perioperative treatment. However, the use of fluorouracil, leucovorin, oxaliplatin, and docetaxel in Asian populations warrants careful consideration, given regional treatment standards and concerns regarding chemotherapyrelated toxicities, including neutropenia. This review summarizes key perioperative trials and highlights the evolving role ofICIs while also addressing emerging evidence on targeted therapies in LAGC. Key considerations include assessment of treatment response, as the validity of pathological response as a surrogate endpoint for survival remains unclear; riskand biomarker-driven patient selection; and unresolved questions regarding the necessity and optimal duration of postoperative therapy. Personalizing postoperative treatment based on prognostic and molecular markers—including clinical stage, pathological response, and circulating tumor DNA status—represents an important next step toward improving outcomes.  \nKeywords: Stomach neoplasms; Neoadjuvant therapy; Immunotherapy; Molecular targeted therapy  \nINTRODUCTION  \nGastric cancer is the fifth most common malignancy worldwide and a major cause of cancerrelated mortality, accounting for more than 600,000 deaths annually [1,2]. In patients with locally advanced gastric cancer (LAGC), surgical resection remains the primary curative approach; however, the high rate of postoperative recurrence has prompted the development of perioperative and adjuvant strategies to improve survival. Historically, treatment approaches for LAGC have differed between Western and Asian countries. In Western regions, perioperative chemotherapy became the standard following the MAGIC and FLOT4 trial","cbCaisHsPJgTlDgn","https://ap.wps.com/l/cbCaisHsPJgTlDgn","pdf",1058086,21,"English","# Abstract\n# Introduction\n## Perioperative and adjuvant strategies in Western regions\n## Perioperative and postoperative strategies in Asia\n## Rationale for neoadjuvant therapy","[{\"question\":\"What is the main clinical role of neoadjuvant therapy in locally advanced gastric cancer?\",\"answer\":\"Neoadjuvant therapy is presented as a promising strategy to improve outcomes and treatment compliance by enabling earlier chemotherapy delivery at relatively high dose intensity.\"},{\"question\":\"Which major trials are highlighted for neoadjuvant chemotherapy and perioperative approaches?\",\"answer\":\"The review cites phase III PRODIGY and RESOLVE for establishing neoadjuvant chemotherapy as a viable option, and MATTERHORN for the potential integration of immune checkpoint inhibitors into perioperative treatment.\"},{\"question\":\"Why is chemotherapy regimen selection cautioned in Asian populations?\",\"answer\":\"The review emphasizes careful consideration of fluorouracil, leucovorin, oxaliplatin, and docetaxel use due to regional treatment standards and concerns about chemotherapy-related toxicities, including neutropenia.\"}]","Neoadjuvant Chemotherapy for Gastric Cancer - Evolving Approaches and Supporting Evidence | PDF",1790133727,53]