Comprehensive multi‐omics analysis of resectable locally advanced gastric cancer: Assessing response to neoadjuvant camrelizumab and chemotherapy in a single‐center, open‐label, single‐arm phase II trial

Background The current standard of care for locally advanced gastric cancer (GC) involves neoadjuvant chemotherapy followed by radical surgery. Recently, neoadjuvant treatment for this condition has involved the exploration of immunotherapy plus chemotherapy as a potential approach. However, the efficacy remains uncertain. Methods A single‐arm, phase 2 study was conducted to evaluate the efficacy and tolerability of neoadjuvant camrelizumab combined with mFOLFOX6 and identify potential biomarkers of response through multi‐omics analysis in patients with resectable locally advanced GC. The primary endpoint was the pathological complete response (pCR) rate. Secondary endpoints included the R0 rate, near pCR rate, progression‐free survival (PFS), disease‐free survival (DFS), and overall survival (OS). Multi‐omics analysis was assessed by whole‐exome sequencing, transcriptome sequencing, and multiplex immunofluorescence (mIF) using biopsies pre‐ and post‐neoadjuvant therapy. Results This study involved 60 patients, of which 55 underwent gastrectomy. Among these, five (9.1%) attained a pathological complete response (pCR), and 11 (20.0%) reached near pCR. No unexpected treatment‐emergent adverse events or perioperative mortality were observed, and the regimen presented a manageable safety profile. Molecular changes identified through multi‐omics analysis correlated with treatment response, highlighting associations between HER2‐positive and CTNNB1 mutations with treatment sensitivity and a favourable prognosis. This finding was further supported by immune cell infiltration analysis and mIF. Expression data uncovered a risk model with four genes (RALYL, SCGN, CCKBR, NTS) linked to poor response. Additionally, post‐treatment infiltration of CD8+ T lymphocytes positively correlates with pathological response. Conclusion The findings suggest the combination of PD‐1‐inhibitor and mFOLFOX6 showed efficacy and acceptable toxicity for locally advanced GC. Extended follow‐up is required to determine the duration of the response. This study lays essential groundwork for developing precise neoadjuvant regimens. The combination of PD‐1‐inhibitor and mFOLFOX6 is effective and well‐tolerated in patients with locally advanced GC HER2‐positive and CTNNB1 mutations are associated with treatment sensitivity and a favourable prognosis in patients with locally advanced GC. Stimulated immune infiltration following chemoimmunotherapy is responsible for the therapeutic response.