Early switch maintenance in gastric cancer: who benefits most?

First-line treatments have historically relied on fluoropyrimidine and platinum agents, but more recent approaches incorporate biomarker-guided targeted therapies, including those based on PD-L1 combined positive score, mismatch repair status or microsatellite instability, and claudin-18.2 expression. Paclitaxel plus ramucirumab has gained recognition as an effective second-line therapy.6 Additionally, a systematic review of 25 phase 3 trials confirmed a strong association between the rate of subsequent chemotherapy and overall survival improvements in gastric cancer.7 Collectively, these findings underscore the critical importance of timely treatment transitions to optimise survival. In the control group, the overall response rate was 16% with ongoing chemotherapy, whereas 32% showed disease progression.1 The switch maintenance group showed an overall response rate (19%) that was similar to the control group but only 9% had progressive disease; disease control was achieved by 85% of individuals who received switch maintenance therapy.