Gastric Cancer in the TNT Era: Have We Resolved the Timing Dilemma or Just Altered Treatment Approaches?
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By
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Serdar Gumus
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Ibrahim Cogal
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Ishak Aydın
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Cem Kaan Parsak
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September 15, 2026
Clinical Scorecard: Gastric Cancer in the TNT Era: Have We Resolved the Timing Dilemma or Just Altered Treatment Approaches?
At a Glance
| Category | Detail |
|---|
| Condition | Locally advanced resectable gastric cancer |
| Key Mechanisms | Perioperative chemotherapy and treatment timing |
| Target Population | Patients with locally advanced gastric cancer |
| Care Setting | Oncology clinical practice |
Key Highlights
- Perioperative chemotherapy is standard care based on landmark studies.
- The independent oncological value of treatment timing remains uncertain.
- Western and East Asian studies approach treatment timing differently.
- Total neoadjuvant therapy (TNT) is gaining traction in treatment protocols.
- Future studies should directly compare perioperative and postoperative treatment.
Guideline-Based Recommendations
Diagnosis
- Diagnosis of locally advanced gastric cancer should include staging and assessment of resectability.
Management
- Perioperative chemotherapy is recommended for locally advanced resectable gastric cancer.
Monitoring & Follow-up
- Monitor treatment response and adjust therapy based on patient tolerance and disease progression.
Risks
- Consider risks of recurrence following resection alone and potential complications from systemic therapy.
Patient & Prescribing Data
Patients with resectable locally advanced gastric cancer
Treatment should consider timing and cumulative exposure to systemic therapy.
Clinical Best Practices
- Utilize a randomized and intention-to-treat framework in clinical trials.
- Incorporate molecular stratification in treatment planning.
- Evaluate both neoadjuvant and adjuvant therapies based on individual patient profiles.
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