Gastric and upper gastrointestinal oncology: integrating breakthroughs from prevention to precision therapeutics

Gastric and upper gastrointestinal (GI) oncology is at a point of transformation, with significant advances in each aspect of the disease continuum. Novel clinical tools and therapies, including randomized phase II and III trials, have provided new standards of care for patients, including preoperative chemoradiation for resectable gastric cancer and PD-L1 stratified immuno-chemotherapy in the metastatic setting. Also, many discoveries are co-evolving with newer methods, such as CAR-T therapy or reintroduced microbial undercover agents or burgeoning precision tools. However, obstacles remain, nursing the costs of CAR-T, the paradoxical survival benefit of PD-L1 P146R polymorphism, and other biological ineptitudes along with health system barriers. In this synthesis, we advocate for more closely integrated "bench-to-community" approaches to apply more effective combinations of health population prevention programs, biomarker-guided therapeutics, and omics profiling studies to accelerate and positively impact healthcare practices addressing biological or health system barriers.