Current status and prospects of immunotherapy for gastric cancer

In recent years, with the deepening understanding of the immune microenviron-ment and immune escape mechanism of gastric cancer, immunotherapy is becoming an important component of the treatment system. Immunotherapy, represented by programmed death receptor 1/programmed death receptor ligand 1 inhibitors, has expanded from the posterior line to the first line and perioperative periods, and its combination with chemotherapy, targeted therapy, as well as radio-therapy can improve the remission rate and survival outcomes of some patients. Meanwhile, chimeric antigen receptor T‑cell immunotherapy targeting antigens such as Claudin18.2, tumor vaccines, and various immune regulation strategies have also shown certain anti‑tumor activity in early clinical studies. However, there are currently three core challenges, including complex mechanisms of resis-tance, which involved immune suppression in the tumor microenvironment, regulatory T cell infiltra-tion, and epigenetic changes. There is a high incidence of immune related adverse reactions in which severe cases require immunosuppressive intervention. Patients′ heterogeneity leads to significant differences in therapeutic efficacy which lacks unified and effective predictive biomarkers. Future development should focus on integrating multidimensional biomarkers to construct a precise hierar-chical system, exploring the optimal combination mode of immunotherapy and radiotherapy, and exploring new immune checkpoint targets such as lymphocyte activation gene 3, T cell immuno-globulin mucin molecule 3, T cell immunoglobulin, and ITIM domain protein, to promote the wide-spread benefits and personalized precision treatment goals of gastric cancer immunotherapy. The author systematically reviews the clinical status, core challenges, and future directions of immuno-therapy for gastric cancer, aiming to provide reference for clinical practice and scientific research exploration, and promote the precision and individualization of gastric cancer immunotherapy.