J Gastric Cancer.
2025 Jan;25(1):133-152. 10.5230/jgc.2025.25.e9.
Conversion Therapy for Stage IV Gastric Cancer: Report From the Expert Consensus Meeting at KINGCA WEEK 2024
- Kim TH
1 - Uyama I2
- Rha SY3
- Bencivenga M4
- An J5
- Wyrwicz L6
- Koo DH7
- Hillegersberg Rv8
- Lee KW9
- Li G10
- Yoshikawa T11
- Badgwell B12
- Lorenzen S13
- Kim IH14
- Lee IS15
- Han HS16
- Hoon H17
- Affiliations
-
- 1Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
- 2Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
- 3Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- 4General and Upper GI Surgery Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
- 5Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 6Department of Oncology and Radiotherapy, Maria Skłodowska-Curie National Cancer Research Institute, Warsaw, Poland
- 7Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- 8Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- 9Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 10Cancer Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- 11Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan
- 12Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
- 13Department of Hematology and Oncology, Klinikum Rechts der Isar Munich, Munich, Germany
- 14Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 15Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 16Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- 17Department of Surgery, Ajou University Hospital, Suwon, Korea
- KMID: 2564655
- DOI: http://doi.org/10.5230/jgc.2025.25.e9
Abstract
- Conversion therapy is a treatment strategy that shifts from palliative systemic therapy to curative surgical treatment for primary and/or metastatic stage IV gastric cancer (GC). To address its clinical statements, the Korean Gastric Cancer Association aims to present a consensus on conversion therapy among experts attending KINGCA WEEK 2024. The KINGCA Scientific Committee and Development Working Group for Korean Practice Guidelines prepared preformulated topics and 9 clinical statements for conversion therapy. The Delphi method was applied to a panel of 17 experts for consensus and opinions. The final comments were announced after the statement presentation and discussed during the consensus meeting session of KINGCA WEEK 2024. Most experts agreed that conversion herapy provides a survival benefit for selected patients who respond to systemic therapy and undergo R0 resection (88.3%). Patients with limited metastases were considered good candidates (94.2%). The optimal timing was based on the response to systemic therapy (70.6%). The regimen was recommended to be individualized (100%) and the duration to be at least 6 months (88.3%). A minimally invasive approach (82.3%) and D2 lymph node dissection (82.4%) were considered for surgery. However, resection for metastases with a complete clinical response after systemic therapy was not advocated (41.2%). All experts agreed on the need for large-scale randomized-controlled trials for further evidence (100%). Recent advancements in treatment may facilitate radical surgery for patients with stage IV GC. Further evidence is warranted to establish the safety and efficacy of conversion therapy.
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