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Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens. [ABSTRACT FROM AUTHOR]

Background: Atezolizumab-bevacizumab is a standard first-line treatment for unresectable hepatocellular carcinoma (uHCC). Given the diversity in HCC etiology and its potential impact on the tumor microenvironment, understanding how different liver disease etiologies affect treatment efficacy is important., Objective: We assessed the influence of liver disease etiology on the efficacy of atezolizumab-bevacizumab and evaluated changes in liver function during treatment with atezolizumab-bevacizumab., Patients and Methods: This study included 390 patients with uHCC treated with first-line atezolizumab-bevacizumab from Asan Medical Center, South Korea, and National Cancer Centre Singapore, Singapore from July 2016 to March 2023. Patients were classified to viral, metabolic dysfunction-associated liver disease (MASLD) and nonviral/non-MASLD groups. Albumin-bilirubin (ALBI) scores were recorded at baseline and every two cycles up to cycle six and at the time of disease progression., Results: The majority of patients presented with viral etiologies (74.1%), and 17.2% had MASLD. Across etiological groups (viral versus MASLD versus nonviral/non-MASLD) no significant differences in objective response rate (23.2% versus 29.9% versus 23.5%, respectively; p = 0.515), progression-free survival (median 5.4 versus 7.7 versus 6.0 months; p = 0.320), and overall survival (18.1 versus 18.9 versus 14.4 months; p = 0.400) were observed. Among the patients with disease progression, ALBI scores at the time of progression were significantly higher than at baseline. Subsequent therapy was administered significantly less often to patients with ALBI grade 3 at disease progression compared with those with ALBI grades 1 or 2 (48.4% versus 78.8%, p = 0.002) CONCLUSIONS: Atezolizumab-bevacizumab demonstrates consistent efficacy regardless of HCC etiology, supporting its use as a first-line treatment across diverse patient populations. Liver function assessments remain crucial for managing therapy and predicting outcomes., Competing Interests: Declarations Funding No external funding was used in the preparation of this manuscript. Conflict of Interest Statement Changhoon Yoo received honoraria from Servier, Bayer, AstraZeneca, Merck Sharp & Dohme, Eisai, Celgene, Bristol Myers Squibb, Ipsen, Novartis, Boryung, Mundipharma, and Roche; and received research grants from Servier, Bayer, AstraZeneca, Ono Pharmaceuticals, Ipsen, Boryung, and Lunit Inc. Jaekyung Cheon received honoraria from AstraZeneca, MSD, Servier, Roche, and Eisai and received research grants from Bayer and Amgen. H.D.K. received honoraria from AstraZeneca, Bristol Myers Squibb, ONO Pharmaceuticals, Boryung Pharmaceuticals, Daiichisankyo MSD, and Boostimmune; received research grants from AstraZeneca and Roche/Genentech; and served as a consultant for Mustbio. Joycelyn Jie Xin Lee received honoraria from Servier, AstraZeneca, Eisai, Bristol Myers Squibb, Beigene, Taiho, Sirtex, and Roche. David Tai received honoraria from Novartis, Celgene, SIRTEX, MSD, BMS, Eisai, IPSEN, Bayer, Roche, Astra Zeneca, and GSK and research grants from Novartis, SIRTEX, and BMS. Sejin Kim, Suat Ying Lee, Hyung-Don Kim, Young Gyu Park, Min-Hee Ryu, and Baek-Yeol Ryoo declare that they have no conflicts of interest that might be relevant to the contents of this manuscript. Ethical Approval This study was approved by the Institutional Review Board of Asan Medical Center (2021-0064) and National Cancer Centre Singapore (Singhealth CIRB 2018/3046) and was performed in accordance with the ethical standards of the Institutional Research Committee and the latest Declaration of Helsinki. Consent to Participate The need for informed consent was waived by the Institutional Review Board of Asan Medical Center. Consent to Publish Not applicable. Data Availability Statement The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Code Availability Not applicable. Author Contributions S.K., S.Y.L., H.D.K., Y.G.P., J.J.X.L., D.T., and C.Y. participated in the study design and gathered patients’ clinical data. S.K. performed primary statistical analysis. S.K. and C.Y. prepared the first version of manuscript. All authors provided critical revision of the manuscript. All authors read and approved the final manuscript., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)