RNA m⁶A modification is a driver and therapeutic target in gastric cancer

N6-methyladenosine (m⁶A), the most abundant modification in eukaryotic RNAs, plays a critical role in regulating RNA stability, expression, and translation. Key m⁶A regulators are up- or down-regulated in human gastric cancer tissues, by Helicobacter pylori and transcription factors, and the aberrant expression is associated with poor patient prognosis. Dynamic m⁶A modification, orchestrated by methyltransferases, demethylases, and m⁶A-binding proteins, profoundly impacts gastric cancer tumorigenesis, metastasis, cancer cell stemness, immune evasion, and resistance to chemotherapy, radiotherapy, and immunotherapy. While aberrant m⁶A modifications and the expression levels of its regulatory factors in blood samples are novel biomarkers in gastric cancer patients, therapies targeting m⁶A regulators have emerged as promising approaches for treating the disease. In summary, m⁶A RNA methylation represents a pivotal epitranscriptomic mechanism with significant implications for gastric cancer biology and precision oncology.