胃癌精准治疗新纪元：聚焦Claudin 18.2、 HER2与免疫检查点抑制剂
The New Era of Precision Therapy for Gastric Cancer: Focusing on Claudin 18.2, HER2, and Immune Checkpoint Inhibitors
摘要: 胃癌，尤其晚期胃癌，长期以来疗效不佳，传统化疗的生存获益已触及瓶颈。肿瘤分子生物学的发展，揭示了胃癌极高的异质性，也为其精准治疗提供了路标。本综述系统性地深入探讨了当前重塑晚期胃癌治疗格局的三大核心支柱：Claudin 18.2靶向治疗、HER2靶向治疗的进化(特别是抗体偶联药物的革命)、以及免疫检查点抑制剂的全程应用。详细阐述了各类药物(包括单克隆抗体、抗体偶联药物、双特异性抗体及细胞疗法)的作用机制与关键临床研究数据，更深入分析了生物标志物检测中的复杂性与优化策略、原发与继发耐药的可能机制，并前瞻性地探讨了基于分子分型的联合治疗策略未来方向。证据表明，一个以生物标志物为导航、以创新药物为武器、以个体化方案为目标的胃癌精准治疗新纪元已经全面来临。
Abstract: Gastric cancer, particularly in its advanced stages, has long been associated with poor therapeutic outcomes, with traditional chemotherapy having reached a plateau in survival benefits. Advances in tumor molecular biology have revealed the high heterogeneity of gastric cancer and provided directions for its precision therapy. This review systematically explores the three core pillars currently reshaping the treatment landscape for advanced gastric cancer: Claudin 18.2-targeted therapy, the evolution of HER2-targeted therapy (particularly the revolution brought by antibody-drug conjugates), and the comprehensive application of immune checkpoint inhibitors. It elaborates on the mechanisms of action and key clinical data of various agents (including monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, and cell therapies), provides an in-depth analysis of the complexities and optimization strategies in biomarker testing, discusses possible mechanisms of primary and secondary resistance, and prospectively explores future directions for combination therapies based on molecular classification. Evidence suggests that a new era of precision therapy for gastric cancer has fully arrived, guided by biomarkers, armed with innovative drugs, and aimed at individualized treatment strategies.
文章引用：王昱博, 张志刚. 胃癌精准治疗新纪元：聚焦Claudin 18.2、 HER2与免疫检查点抑制剂[J]. 临床医学进展, 2026, 16(2): 2094-2101. https://doi.org/10.12677/acm.2026.162607

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