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Cancer Genomics and Diagnostics / Mechanisms of Cancer Metastasis / Gastric Cancer Management and Outcomes · Journal article
Oncology Reports · August 14, 2026
A consensus or society position rather than new primary data.
This is a narrative review synthesizing current knowledge of molecular classification systems and mechanisms of therapeutic resistance in gastric cancer precision medicine. It identifies key barriers to clinical translation (cost, tissue availability, standardization, intratumoral heterogeneity) and proposes future directions including multi-target strategies and dynamic adaptive therapy, but does not report original clinical trial data.
Journal article. Gastric cancer patients across geographic populations, emphasis on East Asian populations..
ACRG molecular classification is more operationally suited for East Asian populations; TCGA better suited for mechanistic exploration Acquired resistance to HER2-targeted therapy and immune checkpoint inhibitors identified as core bottleneck in precision therapy Cancer-associated fibroblasts impair drug penetration and promote epithelial-mesenchymal transition via physical barriers and paracrine signaling
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Clinicians and researchers should recognize that molecular classification choice depends on population context (ACRG for East Asian patients, TCGA for mechanistic study), and that addressing acquired resistance mechanisms—particularly in the tumor microenvironment—is essential for improving precision therapy outcomes. This review highlights the gap between static molecular subtyping and the dynamic, multi-dimensional approach needed for clinical translation.
A comprehensive review synthesizing current molecular classification systems and resistance mechanisms in gastric cancer precision therapy, offering expert perspectives on clinical translation barriers and future directions rather than reporting original trial data.
Clinicians and researchers should recognize that molecular classification choice depends on population context (ACRG for East Asian patients, TCGA for mechanistic study), and that addressing acquired resistance mechanisms—particularly in the tumor microenvironment—is essential for improving precision therapy outcomes. This review highlights the gap between static molecular subtyping and the dynamic, multi-dimensional approach needed for clinical translation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
The emergence of molecular classifications for gastric cancer (GC), The Cancer Genome Atlas (TCGA) and Asian Cancer Research Group (ACRG), has advanced targeted and immunotherapies, but their clinical translation faces real-world obstacles including high cost, tissue availability, standardization, and intratumoral heterogeneity.The present review critically compares the two classification systems regarding prognostic utility across geographic populations and boundary conflicts, noting that ACRG is more operable in East Asian populations whereas TCGA is better suited for mechanistic exploration.Focusing on acquired resistance as a core bottleneck in precision therapy, mechanisms underlying anti-Human Epidermal Growth Factor Receptor 2 (HER2) resistance and primary/secondary resistance to immune checkpoint inhibitors (ICIs) were systematically dissected, while also addressing immune-related adverse events and pseudo-/hyperprogression.Moreover, non-immune elements of the tumor microenvironment deserve attention: Cancer-associated fibroblasts limit drug penetration and promote epithelial-mesenchymal transition through physical barriers and paracrine signaling; metabolic reprogramming (high glycolysis and glutamine addiction) impairs chemotherapy and ICI efficacy via an acidic microenvironment and metabolic competition.Finally, multi-target combination strategies are envisioned based on pathway redundancy, along with liquid biopsy-driven dynamic adaptive therapy and single-cell/spatial multi-omics integration for precise microenvironment intervention.The present review aims to offer a systematic reference for moving GC precision therapy from static subtyping toward dynamic, multi-dimensional integration.
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