Living with itGastric & gastro-oesophageal junction cancer

Back to the Gastric & gastro-oesophageal junction cancer hub →43 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

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Decisions you may face

10 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

Localised2 Advanced first line3 Later lines4 Prevention and screening2 Early (T1a) disease Resectable stage II-III (Western)3 Resectable stage II-III (Asian practice)Advanced, HER2-positive, first line4 Advanced, HER2-negative, PD-L1 CPS ≥5 (or ≥1), first line5 Advanced, CLDN18.2-positive (≥75%), HER2-negative, first line3 Advanced, HER2-negative, PD-L1 CPS <1 and CLDN18.2-negative2 Second line, HER2-positive Second line, HER2-negative4 Third line and beyond Peritoneal metastases

Red cards

From the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Bleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
CAPOX (capecitabine, oxaliplatin)FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)FOLFOX (5-FU, leucovorin, oxaliplatin)Paclitaxel / nab-paclitaxel Trifluridine/tipiracil source
Emergency services now
Hypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Durvalumab Nivolumab Pembrolizumab Tislelizumab source
Emergency services now
Skin reaction
Blisters, peeling, or sores in the mouth or eyes with a rash. Enfortumab vedotin carries a boxed warning for Stevens-Johnson syndrome and toxic epidermal necrolysis, mostly in the first cycle.
Sonesitatug vedotin Trastuzumab deruxtecan source
Emergency services now
Bowel perforation
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Ramucirumab source
Emergency services now
Cytokine release syndrome
Fever of 38 C or higher is grade 1 CRS; fever with low blood pressure, fast heartbeat, breathlessness or low oxygen is grade 2 or higher. The labels carry a boxed warning and say to report fever immediately.
Satricabtagene autoleucel source
Call the 24-hour line now
Interstitial lung disease or pneumonitis
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Trastuzumab deruxtecan source

See all on the product pages:CAPOX (capecitabine, oxaliplatin)Durvalumab FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)FOLFOX (5-FU, leucovorin, oxaliplatin)Nivolumab Paclitaxel / nab-paclitaxel Pembrolizumab Ramucirumab Satricabtagene autoleucel Sonesitatug vedotin Tislelizumab Trastuzumab deruxtecan Trifluridine/tipiracil·Printable cards in the navigator

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Gastric & gastro-oesophageal junction cancer

Generated from this cancer's standard of care, biomarkers, and pipeline · 43 questions

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?
Why: Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example HER2, PD-L1 CPS, CLDN18.2, MSI, FGFR2b), and what were the results?
Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?
Why: Recognised subtypes for this cancer include Intestinal type, Diffuse / signet-ring type, TCGA: EBV-positive.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

Localised

For my situation (localised), which of the standard options do you recommend and why?
Why: Guideline options include: Perioperative FLOT ± durvalumab; D2 gastrectomy.
Am I a candidate for Durvalumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced first line

For my situation (advanced first line), which of the standard options do you recommend and why?
Why: Guideline options include: Chemotherapy + PD-1 ± trastuzumab ± zolbetuximab by biomarker.
Am I a candidate for Nivolumab, Pembrolizumab, Trastuzumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Later lines

For my situation (later lines), which of the standard options do you recommend and why?
Why: Guideline options include: T-DXd (HER2+), zanidatamab, CLDN18.2 CAR-T/ADC in trials.
Am I a candidate for Trastuzumab deruxtecan, Zanidatamab, Satricabtagene autoleucel or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Prevention and screening

For my situation (prevention and screening), which of the standard options do you recommend and why?
Why: Guideline options include: H. pylori eradication reduces incidence; endoscopic screening programmes in Japan and Korea (biennial from age 40-50) detect most cancers at a curable stage. No population screening in the West. Prophylactic total gastrectomy for germline CDH1 carriers.

Early (T1a) disease

For my situation (early (t1a) disease), which of the standard options do you recommend and why?
Why: Guideline options include: Endoscopic submucosal dissection for well-differentiated mucosal tumours ≤2 cm without ulceration (expanded criteria in Japan); otherwise gastrectomy.

Resectable stage II-III (Western)

For my situation (resectable stage ii-iii (western)), which of the standard options do you recommend and why?
Why: Guideline options include: Perioperative FLOT + durvalumab (MATTERHORN: OS HR 0.78, pCR 19%) with D2 gastrectomy; FOLFOX/CAPOX perioperatively for patients unfit for docetaxel.
Am I a candidate for FLOT (5-FU, leucovorin, oxaliplatin, docetaxel), Durvalumab, CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of MATTERHORN apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Resectable stage II-III (Asian practice)

For my situation (resectable stage ii-iii (asian practice)), which of the standard options do you recommend and why?
Why: Guideline options include: D2 gastrectomy then adjuvant S-1 (ACTS-GC) or CAPOX (CLASSIC) for 6-12 months; neoadjuvant approaches increasingly adopted.
Am I a candidate for CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CLASSIC apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Advanced, HER2-positive, first line

For my situation (advanced, her2-positive, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Trastuzumab + fluoropyrimidine/platinum + pembrolizumab (KEYNOTE-811, PD-L1 CPS ≥1); zanidatamab + chemotherapy ± tislelizumab after HERIZON-GEA-01 (PFS 12.4 vs 8.1 months; sBLA 2026).
Am I a candidate for Trastuzumab, Zanidatamab, Pembrolizumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of ToGA and HERIZON-GEA-01 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Advanced, HER2-negative, PD-L1 CPS ≥5 (or ≥1), first line

For my situation (advanced, her2-negative, pd-l1 cps ≥5 (or ≥1), first line), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab (CheckMate 649) or pembrolizumab (KEYNOTE-859) or tislelizumab (RATIONALE-305) with FOLFOX or CAPOX; add zolbetuximab if CLDN18.2-positive (sequencing/combination under study).
Am I a candidate for Nivolumab, Pembrolizumab, Tislelizumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CheckMate 649 and KEYNOTE-859 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Advanced, CLDN18.2-positive (≥75%), HER2-negative, first line

For my situation (advanced, cldn18.2-positive (≥75%), her2-negative, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Zolbetuximab + mFOLFOX6 or CAPOX (SPOTLIGHT/GLOW). PD-L1 CPS ≥5 double-positives: either add-on; combination trials ongoing.
Am I a candidate for Zolbetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of SPOTLIGHT & GLOW apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Advanced, HER2-negative, PD-L1 CPS <1 and CLDN18.2-negative

For my situation (advanced, her2-negative, pd-l1 cps <1 and cldn18.2-negative), which of the standard options do you recommend and why?
Why: Guideline options include: FOLFOX or CAPOX chemotherapy alone; MSI-high tumours get PD-1 blockade regardless of CPS.
Am I a candidate for FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Second line, HER2-positive

For my situation (second line, her2-positive), which of the standard options do you recommend and why?
Why: Guideline options include: Trastuzumab deruxtecan 6.4 mg/kg (DESTINY-Gastric04, OS 14.7 vs 11.4 months) if HER2 persists on re-biopsy or ctDNA.
Am I a candidate for Trastuzumab deruxtecan, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of DESTINY-Gastric04 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Second line, HER2-negative

For my situation (second line, her2-negative), which of the standard options do you recommend and why?
Why: Guideline options include: Ramucirumab + paclitaxel (RAINBOW, OS 9.6 vs 7.4 months); CLDN18.2-positive: sonesitatug vedotin after CLARITY-Gastric 01 (2026) or satri-cel CAR-T (China).
Am I a candidate for Ramucirumab, Paclitaxel / nab-paclitaxel, Sonesitatug vedotin or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of RAINBOW and CLARITY-Gastric 01 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Third line and beyond

For my situation (third line and beyond), which of the standard options do you recommend and why?
Why: Guideline options include: Trifluridine/tipiracil (TAGS, OS 5.7 vs 3.6 months); irinotecan; clinical trials (FGFR2b, CLDN18.2 bispecifics, T-cell engagers).
Am I a candidate for Trifluridine/tipiracil, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Peritoneal metastases

For my situation (peritoneal metastases), which of the standard options do you recommend and why?
Why: Guideline options include: Systemic therapy; intraperitoneal paclitaxel, HIPEC, and PIPAC in trials; palliative gastrectomy not recommended (REGATTA).

Any stage

Are there clinical trials I could join, for example of Sonesitatug vedotin, Satricabtagene autoleucel, Disitamab vedotin, Zanidatamab?
Why: Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?
Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
Why: Supportive care improves quality of life and helps patients complete treatment.
I read that “Peritoneal metastasis”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “Heterogeneous CLDN18.2/HER2 expression”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.

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Model panel1 model

Machine commentary by named AI models on a date, not clinical review. Claims are tied to the record's own sources; check them before relying on anything here.

FableAnthropic · v5.12026-09-17low confidence

The record's burden figures, biomarker framework (HER2, PD-L1 CPS, CLDN18.2, MSI) and the broad shape of first-line stratification match what the Wikipedia article and the NCCN and ESMO guideline pages cover, and the trial-derived numbers it quotes (RAINBOW, TAGS, DESTINY-Gastric04) are internally consistent with its linked trial entries. Weaknesses are mostly internal: the tldr calls HER2 and FGFR2b new targets when the record's own history and open problems say otherwise; the second-line HER2 row requires re-biopsy or ctDNA confirmation while the open problems say this is not standard; the 'Later lines' guideline block mislabels a PMC article as the NCCN guideline and attaches an ESMO-MCBS score that the sources do not confirm; the 1990 screening date has no reference; and the history list carries duplicate entries (ToGA twice in 2010, two 2021 rows, two 2024 zolbetuximab rows, satri-cel twice in 2025) as do the open problems. Radiotherapy and chemoradiation are absent from the standard-of-care table despite still appearing in NCCN. The 2026 claims about zanidatamab and sonesitatug vedotin cannot be checked against any listed source.

Right 1Disputed 2Missing 1Unclear 3Show verdicts

Right
~1 million cases per year, the fifth most common cancer; ~660,000 deaths per year, fifth among cancers
The Wikipedia article's epidemiology section carries GLOBOCAN-derived figures of roughly one million new cases and about 660,000 deaths a year, ranking stomach cancer fifth for both incidence and mortality, and it describes the East Asian concentration and the H. pylori link the summary gives.
Wikipedia
Disputed
A cancer with three new targets in five years: Claudin 18.2, FGFR2b, and HER2
The record's own history dates HER2 to ToGA in 2010, so it is not a new target, and its own open problems say FGFR2b benefit is uncertain after a mixed FORTITUDE-101 with no approved drug. The NCCN guideline lists HER2, PD-L1, MSI/dMMR and CLDN18.2 as the biomarkers directing therapy; FGFR2b is not among them. The tldr overstates what the rest of the record supports.
NCCN Gastric Cancer guideline
Unclear
1990: Japan and Korea institute endoscopic screening programmes
This history entry has an empty refs list and a single year for two countries whose programmes began at different times and did not start with endoscopy. None of the listed sources gives start dates that would settle the 1990 date or the 'endoscopic' description; the Wikipedia article only notes that screening exists in Japan and Korea.
Wikipedia
Missing
Localised disease is treated with gastrectomy and D2 lymphadenectomy plus perioperative chemotherapy
The standard-of-care table contains no radiotherapy setting at all, although the NCCN guideline still lists postoperative chemoradiation as an option for resected disease that did not receive preoperative therapy, and preoperative chemoradiation for GEJ tumours. The record even links the INT-0116 trial but never says where, if anywhere, chemoradiation now sits.
NCCN Gastric Cancer guideline
Unclear
Later lines: esmoMcbs 2 (DESTINY-Gastric01 trastuzumab deruxtecan); version NCCN Guidelines: Gastric Cancer
The guideline block is labelled as the NCCN guideline but points to a PMC article rather than the NCCN site, and it attaches an ESMO-MCBS score of 2 to an NCCN entry. The PMC link as listed does not let a reader confirm either the NCCN category or the ESMO-MCBS grade for DESTINY-Gastric01, so the provenance of this score is not settled.
NCCN Guidelines: Gastric Cancer (Later lines)
Disputed
Trastuzumab deruxtecan 6.4 mg/kg (DESTINY-Gastric04) if HER2 persists on re-biopsy or ctDNA; NCCN Category 1
The record contradicts itself: the second-line row makes HER2 persistence on re-biopsy or ctDNA a condition of treatment, while the open problems state that re-biopsy or ctDNA before second-line targeting is not standard. The NCCN guideline is the cited authority for the Category 1 label and for any re-testing requirement, and the record does not show that it imposes one.
NCCN Gastric Cancer guideline
Unclear
zanidatamab + chemotherapy ± tislelizumab after HERIZON-GEA-01 (PFS 12.4 vs 8.1 months; sBLA 2026); from 2026 the CLDN18.2 ADC sonesitatug vedotin (CLARITY-Gastric 01)
These 2026 results and the regulatory steps are presented as part of standard care, yet the only sources listed are guideline landing pages and Wikipedia, none of which is shown to incorporate them. The record's own linked trial entries describe announcements, not guideline adoption, so whether either agent is guideline-endorsed first- or second-line therapy cannot be checked from the sources given.
ESMO gastric cancer guideline

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ProvenanceLast edited 2026-09-18 · Jude Gomila · Merge duplicate trial records onto their named keepers · diff · file · history

Wikipedia

Stomach cancer

Sources & links