ArchiveAdvances in the identification of molecular biomarkers and the development of targeted therapies have enhanced the prognosis of patients with advanced gastric cancer. Several established biomarkers have been widely integrated into routine clinical diagnostics of gastric cancer to guide personalized treatment. Human epidermal growth factor receptor 2 (HER2) was the first molecular biomarker to be used in gastric cancer with trastuzumab being the first approved targeted therapy for HER2-positive gastric cancer. Programmed death-ligand 1 positivity and microsatellite instability can guide the use of immunotherapies, such as pembrolizumab and nivolumab. More recently, zolbetuximab has been approved for patients with claudin 18.2-positive diseases in some countries. More targeted therapies, including savolitinib for MET-positive patients, are currently under clinical investigation. However, the clinical application of these diagnostic approaches could be hampered by many existing challenges, including invasive and costly sampling methods, variability in immunohistochemistry interpretation, high costs and long turnaround times for next-generation sequencing, the absence of standardized and clinically validated diagnostic cut-off values for some biomarkers, and tumor heterogeneity. Novel testing and analysis techniques, such as artificial intelligence-assisted image analysis and multiplex immunohistochemistry, and emerging therapeutic strategies, including combination therapies that integrate immune checkpoint inhibitors with targeted therapies, offer potential solutions to some of these challenges. This article reviews recent progress in gastric cancer testing, outlines current challenges, and explores future directions for biomarker testing and targeted therapy for gastric cancer.
Alterations in the mesenchymal-epithelial transition factor (MET) gene are critical drivers of non-small cell lung cancer (NSCLC). In recent years advances in precision therapies targeting MET alterations have significantly expanded treatment options for NSCLC patients. These alterations include MET exon 14 skipping mutations (MET exon 14 skipping), MET gene amplifications, MET point mutations (primarily kinase domain mutations), and MET protein overexpression. Accurate identification of these alterations and appropriate selection of patient populations and targeted therapies are essential for improving clinical outcomes. The East China Lung Cancer Group, Youth Committee (ECLUNG YOUNG, Yangtze River Delta Lung Cancer Cooperation Group) has synthesized insights from China’s innovative drug development landscape and clinical practice to formulate an expert consensus on the diagnosis and treatment of NSCLC patients with MET alterations. This consensus addresses key areas, such as optimal testing timing, testing methods, testing strategies, quality control measures, and treatment approaches. By offering standardized recommendations, this guidance aims to streamline diagnostic and therapeutic processes and enhance clinical decision-making for NSCLC with MET alterations.
Identifying biomarkers that predict the efficacy and prognosis of chemoradiotherapy is important for individualized clinical treatment. We previously reported that high murine double minute 1 (MDM1) expression in patients with rectal cancer is linked to a favorable chemoradiation response. In this study the role of MDM1 in the chemoradiotherapy response in colorectal cancer (CRC) patients was evaluated.
Colony formation and cell proliferation assays as well as xenograft models were used to determine if MDM1 expression affects the sensitivity of CRC cells to chemoradiation. RNA sequencing revealed that MDM1 regulates tumor protein 53 (TP53) expression and apoptosis. A series of molecular biology experiments were performed to determine how MDM1 affects p53 expression. The effects of inhibitors targeting apoptosis on MDM1 knockout cells were evaluated.
Gene expression profiling revealed that MDM1 is a potential chemoradiotherapy sensitivity marker. The sensitivity of CRC cells to chemoradiation treatment decreased after MDM1 knockout and increased after MDM1 overexpression. MDM1 affected p53 expression, thereby regulating apoptosis. MDM1 overexpression limited YBX1 binding to TP53 promoter, regulated TP53 expression, and rendered CRC cells more sensitive to chemoradiation. In CRC cells with low MDM1 expression, a combination of apoptosis-inducing inhibitors and chemoradiation treatment restored sensitivity to cancer therapy.
The current study showed that MDM1 expression influences the sensitivity of CRC cells to chemoradiation by influencing p53 and apoptosis pathways, which is the basis for the underlying molecular mechanism, and serves as a possible predictive marker for chemoradiotherapy prognosis.
Immune checkpoint inhibitors (ICIs) have demonstrated substantial efficacy in patients with advanced non-small cell lung cancer (NSCLC). However, the optimal duration of ICI therapy remains unclear, and limited real-world data are available. The aim of this study was to evaluate the relationship between ICI therapy duration and overall survival (OS) in patients who achieved varying best overall response (BOR) during ICI treatment, and to compare patients treated for 6 to 18 months vs. at least 18 months.
This retrospective cohort study included adult patients diagnosed with advanced NSCLC who received ICI therapy at the Zhejiang Cancer Hospital between 2017 and 2022. Data collection ended on May 1, 2024, and statistical analysis was performed between May and June 2024.
Using strict entry criteria, we screened 487 patients with advanced NSCLC and identified 134 eligible patients. Among these patients, the median durations of immunotherapy and follow-up were 24.57 months and 43.60 months, respectively. The objective response rate (ORR) was 58.2%, and the median progression-free survival (PFS) was 10.6 months. Median OS was not reached. At the last follow-up, 54 patients had no disease progression, and 118 patients remained alive. Patients treated with ICI therapy for ≥ 18 months had superior survival to those treated for 6 to 18 months (P = 0.039). Further analysis revealed that the survival benefit was associated with BOR during ICI therapy. Specifically, patients achieving complete response/partial response (CR/PR) who received ≥ 18 months of ICI therapy had a trend toward longer median OS than those treated for 6 to 18 months, but the difference did not reach statistical significance (P = 0.177). Patients with stable disease (SD) who received ≥ 18 months of ICI therapy had a statistically longer median OS than those treated for 6 to 18 months (P = 0.019). Among patients treated with ICIs for ≥ 18 months, 24 continued with ICI-based therapy and achieved a median PFS2 of 6.67 months, an ORR of 33.3%, and a disease control rate (DCR) of 83.3%.
This study provides real-world evidence and novel insights into the need for continuing ICI therapy beyond 18 months in patients with advanced NSCLC who do not exhibit progressive disease. For patients achieving SD during ICI therapy, a treatment duration of at least 18 months appears appropriate. For patients achieving CR/PR, treatment decisions should be individualized according to patient-specific circumstances. However, owing to the retrospective study design, potential selection bias and confounding factors might have influenced the results. Therefore, our findings require further validation in prospective clinical studies.
No. 86 Xueyuan South Road, Haidian District, Beijing
010-62662699(Operation and Technical Support)
qkjq@cast.org.cn
Copyright © 2025 China Association for Science and Technology. All rights reserved. For all open access content, the relevant licensing terms apply.
Sponsored by the Office of the Leading Group for Cybersecurity and Informatization of CAST, and supported by Science and Technology Review Publishing House
