Tailored Treatment Strategies Based on New Molecular Classifications

Recent years have seen a change in the treatment options for gastric cancer (GC) from a standard to a tailored approach. Different individualized procedures range from endoscopic resection, D2 with an open or minimally invasive approach, neoadjuvant therapy followed by extended surgery, or the inclusion of hyperthermic intraperitoneal chemotherapy (HIPEC). New molecular classifications of GC have been recently introduced and translational clinical studies are ongoing. These classifications are expected to be included in the multidisciplinary treatment of GC. In particular, in the group with microsatellite instability a less extended lymphadenectomy may be proposed. Also tailored neoadjuvant treatment may be proposed according to molecular classifications. The group of patients with epithelial-to-mesenchymal transition shows very high propensity for peritoneal dissemination as well as N-metastases, and may benefit from prophylactic HIPEC and extended lymphadenectomy, when confirmed in prospective trials.