Discover how systemic and intraperitoneal chemotherapy, combined with modern targeted therapies, play a vital role in treating stomach cancer.

Stomach, or gastric, cancer remains a significant global health challenge, often claiming hundreds of thousands of lives each year [1]. Because early stages frequently present without distinct symptoms, many patients are diagnosed only after the disease has reached an advanced stage or after it has recurred following surgery [2], [8]. Even when surgical removal of the tumor is possible, the ongoing risks of residual cells, micrometastatic spread, and disease recurrence mean that additional medical interventions are usually necessary [1].

The Role of Systemic Chemotherapy

Systemic chemotherapy circulates throughout the entire body to target and destroy rapidly dividing cancer cells [6]. It is utilized across different clinical settings: neoadjuvant therapy given before surgery to shrink tumors, adjuvant therapy given afterward to eliminate remaining cancer cells, and palliative treatment for advanced disease [1]. Traditional combination regimens for advanced gastric cancer frequently incorporate drugs like 5-fluorouracil (5-FU) and cisplatin [2]. While these approaches can yield response rates between 20% and 40%, managing advanced disease remains complex [2]. Newer agents, including taxanes and irinotecan, are also studied to expand therapeutic benefits [2]. Because traditional systemic drugs affect the entire body, they can cause side effects such as nausea, vomiting, and potential long-term impacts on major organs like the heart and kidneys [6].

Targeted Therapies and Immunotherapy

To improve outcomes and minimize unnecessary toxicity, modern cancer care increasingly integrates targeted therapies and immunotherapies alongside or in place of traditional cytotoxic drugs [1]. For instance, targeted options like zolbetuximab are utilized for patients whose tumors test positive for specific biomarkers such as CLDN18.2 [7]. In some cases, significant tumor reduction from systemic treatments can successfully enable conversion surgery, rendering previously unresectable tumors removable [7]. Furthermore, emerging research explores biomarker-driven combinations, such as bispecific targeting therapies paired with immunotherapy, offering promising avenues for specific patient profiles [5].

Intraperitoneal Chemotherapy Approaches

Beyond traditional intravenous delivery, medical strategies also explore local administration routes. Radical surgery combined with chemotherapy remains a cornerstone of treatment, but the optimal timing—whether neoadjuvant, adjuvant, or perioperative—remains a subject of ongoing clinical evaluation [3]. Innovative findings highlight the value of intraperitoneal chemotherapy, which involves delivering medications directly into the abdominal cavity [3]. Administering chemotherapy intraperitoneally earlier in the treatment algorithm is being investigated as a targeted method to help prevent peritoneal recurrence in advanced gastric cancer [3].

Future Directions in Multimodal Care

Treating gastric cancer effectively requires a personalized, multimodal strategy that often combines surgery, radiation, systemic medications, and novel drug delivery systems [4], [6]. Researchers continue to investigate drug repurposing, polymer-based drug delivery systems to tune pharmacokinetics, and combination therapies designed to enhance tumor immunogenicity [4], [6], [8]. These ongoing advancements aim to improve survival rates, enhance precision, and protect healthy organs from irreversible damage [1], [6].

Sources

This article summarises published research for a general audience. It is not medical advice — talk to a qualified clinician about your own situation. Need help finding one? Browse doctors.

Systemic and Local Chemotherapy Options for Stomach Cancer

The Role of Systemic Chemotherapy

Targeted Therapies and Immunotherapy

Intraperitoneal Chemotherapy Approaches

Future Directions in Multimodal Care

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