Study aid only. Verify against current guidelines, primary literature, staging manuals, and prescribing information before clinical use.

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Advanced Gastric / GEJ Adenocarcinoma — Systemic Therapy

First-line Second-line Later-line SECOND-LINE THIRD-LINE / LATER Advanced gastric / GEJ adenocarcinoma First-line by biomarker Second-line Third-line + HER2+ Trastuzumab + chemo + pembrolizumab KEYNOTE-811 ↗ PD-L1+ Nivolumab + chemo CheckMate 649 ↗ CLDN18.2+ Zolbetuximab + chemo SPOTLIGHT/GLOW ↗ Biomarker-neg Chemo doublet (FOLFOX/CAPOX) backbone Antiangiogenic Ramucirumab + paclitaxel RAINBOW ↗ HER2+ ADC Trastuzumab deruxtecan DESTINY-Gastric01 ↗ Cytotoxic Trifluridine/tipiracil TAGS ↗ Other Single-agent chemo / trial per fitness