The concept and strategy of advanced
gastric cancer treatment have gradually undergone profound changes with the in-depth understanding of the biology and heterogeneous characteristics of
gastric cancer. Moreover, the development and application of new anticancer drugs, including
chemotherapy drugs, molecularly targeted drugs and
immunotherapy drugs for advanced
gastric cancer are reported. The connotation of conversion
therapy refers to the unresectable or borderline resectable
tumors for surgical technical and/or oncological reasons, after active and effective
chemotherapy and other comprehensive treatment, the primary gastric lesions can be reduced to a lower stage, while the metastatic lesions can be effectively controlled, to achieve R0 resection and improve the long-term survival rate. Current promising research results of conversion
therapy are mostly from single-arm phase II clinical studies with small samples or retrospective studies. Conversion
therapy still faces many challenges, including limited diagnostic and assessment methods, insufficient evidence of highly effective treatment regimens, difficulty in clarifying surgical indications, etc. Therefore, the integrated conversion
therapy for advanced
gastric cancer needs to be carried out with the close cooperation of a multidisciplinary team. Prospective, multi-center randomized controlled trial studies should be conducted in the future, and
precision medicine such as molecular biology should be combined to provide better anticancer drug regimens and higher-level clinical evidence for conversion
therapy of advanced
gastric cancer.