TRANSLATIONAL ONCOLOGY (L VECCHIONE, SECTION EDITOR) Personalised Treatment in Gastric Cancer: Myth or Reality? Noelia Tarazona 1,2 & Valentina Gambardella 1,3 & Marisol Huerta 1 & Susana Roselló 1 & Andrés Cervantes 1 # Springer Science+Business Media New York 2016 Abstract Despite recent diagnostic and therapeutic advances, the survival of patients with gastric cancer is still poor. The majority of patients are diagnosed with advanced disease and chemotherapy represents the only possible therapeutic ap- proach. However, chemotherapy seems to have reached an efficacy plateau in this setting. Gastric cancer is a complex and heterogeneous disease because it emerges from multiple interactions of genetic, environmental and host factors. A bet- ter understanding of its molecular characteristics may lead to an improvement of outcomes. The recent molecular classifi- cation by The Cancer Genome Atlas project divides gastric cancer into four subtypes that could be taken into consider- ation in future clinical trials with targeted agents. So far trastuzumab, a monoclonal antibody addressing the HER2 receptor, is the only targeted agent approved in the first-line setting, but only in patients overexpressing HER2. Negative data have been obtained in first-line therapy when antiangiogenics, anti-EGFR or anti-MET monoclonal anti- bodies have been studied in randomised controlled trials. Ramucirumab, a monoclonal antibody binding to VEGFR2, is the only antiangiogenic agent currently recommended in patients progressing after first-line treatment. In this review, we discuss whether personalised therapy may have a role in gastric cancer. Keywords Gastric cancer . Targeted therapy . Trastuzumab . Molecular classification . Biomarkers . Patient selection . Clinical trial Introduction Gastric cancer (GC) is a global health issue and the third leading cause of cancer death worldwide [1]. Over one million new cases of GC are diagnosed each year and more than 70 % occur in developing countries, especially in East Asia [2]. Its high mortality is associated with both the absence of signifi- cant symptoms in the early stages and the lack of validated screening programmes in western countries. Consequently, most cases are diagnosed at an advanced stage, which is relat- ed to a poor prognosis [3, 4]. GC is a complex, heterogeneous and multifactorial disease. Chemotherapy (CT) remains the main treatment for advanced disease and median overall sur- vival (OS) is around 12 months [5]. There is an urgent need for new treatments and strategies to improve outcomes. However, although multiple targeted agents are under investigation, so far, only trastuzumab and ramucirumab have demon- strated efficacy in advanced GC and have a regulatory approval [6••, 7••]. The Age of Chemotherapy Prognosis of GC is mainly related to the stage of the disease at diagnosis. Radical surgery remains the only curative treatment for patients diagnosed with localised disease. Despite this, the expected 5-year survival rate is around 30 % in western This article is part of the Topical Collection on Translational Oncology Noelia Tarazona and Valentina Gambardella contributed equally to this work. * Andrés Cervantes andres.cervantes@uv.es 1 Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain 2 Rio Hortega Contract CM15/00246, Valencia, Spain 3 ESMO Translational Research Fellow, Valencia, Spain Curr Oncol Rep (2016) 18:41 DOI 10.1007/s11912-016-0525-x