Oligoprogression in Advanced Gastric and Gastroesophageal Junction Cancer: Integrating Local Therapy, Systemic...

To critically evaluate oligoprogression in advanced gastric and gastroesophageal junction (GEJ) cancer and propose a practical multidisciplinary framework integrating local therapy, systemic treatment decisions, and biomarker reassessment.

We reviewed direct gastric/GEJ evidence and clearly distinguished it from evidence extrapolated from oligometastatic disease and other tumor types.

No prospective comparative study has demonstrated that local treatment with continuation of systemic therapy improves survival specifically in gastric/GEJ oligoprogression. In carefully selected patients, local treatment may be considered to delay the next systemic therapy, prevent or relieve symptoms, maintain local control, or preserve quality of life. Tissue rebiopsy or circulating tumor DNA analysis may be useful when technically obtainable and likely to change management. HER2 reassessment has established clinical relevance after HER2-directed treatment, whereas repeat assessment of CLDN18.2, PD-L1, FGFR2b, and other emerging targets remains exploratory. A negative plasma circulating tumor DNA result does not exclude resistant disease, particularly in low-volume, peritoneal, or central nervous system progression.

Management should remain individualized and multidisciplinary, with explicit recognition that the proposed framework is provisional and that a survival benefit from local therapy with systemic treatment continuation remains unproven.