Neoadjuvant Selection, Autoimmune Considerations, and Proactive Nutrition Planning in Locally Advanced Gastric Cancer

This segment explores decision making for a fit patient with locally advanced, PD-L1–negative, biomarker-negative gastric cancer and examines how DFLOT is approached in real world practice. The discussion begins with neoadjuvant therapy selection, with panelists noting that PD-L1 status does not alter eligibility for DFLOT based on current evidence and that patients with well-controlled autoimmune disease may still be considered through multidisciplinary collaboration and informed consent. The conversation then shifts to preoperative optimization. For patients already experiencing weight loss, the panel underscores the importance of early nutritional intervention, including consideration of feeding tube placement at the time of staging laparoscopy. They describe how proactive enteral support can help patients maintain protein intake, preserve performance status, and complete therapy without interruption. The group also reviews misconceptions about feeding tubes, clarifying that gastrostomy placement does not compromise later surgical options when performed appropriately. Overall, the segment highlights practical strategies to support treatment tolerance and surgical readiness.