A New Paradigm in the Treatment of Gastric Cancer

Gastric Cancer (GC) is the fourth common cancer worldwide. It has a geographical distribution affecting mainly the developing countries much more than the developed ones. It is an aggressive disease with poor outcome. Little breakthroughs were achieved in the treatment of GC in the last few decades. These were confined to chemotherapy and surgical techniques. The development of gastric cancer is a complex, multistep process, which involves multiple genetic and epigenetic alterations. The previous classifications of GC had limited impact on its management and prognosis. A novel molecular classification will enhance our understanding of the cancer of the stomach and it will individualize our therapy in a targeted manner for more robust results and better prognosis. According to The Cancer Genome Atlas Project (TCGA), GC has been recently divided into 4 categories according to the molecular imprint specification. These 4 subtypes are Epstein-Barr virus positive tumors (EBVp), microsatellite instability tumors (MSI), genomically stable tumors (GS) and tumors with chromosomal instability (CIN). There is an immense diversity in the pathways where targeted and immunotherapeutic agents could treat gastric cancer. We propose a possible new treatment approach against gastric cancer guided by its genetic fingerprint.