Advances in immunotherapy for advanced gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Ganqing ^1,2 , LI Luyao ^1,2 , LIU Jixiang ^2,3 , DONG Na ¹ ,  FAN Ruifang ²

1. The Second Clinical Medical College, Lanzhou University, Lanzhou 730030, P. R. China;
2. Department of General Surgery, The 940th Hospital, Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, P. R. China;
3. Northwest Minzu University, Lanzhou 730030, P. R. China;

Corresponding author：

FAN Ruifang, Email: fanruif@163.com

Keywords：

advanced gastric cancer; immune checkpoint inhibitors; cellular immunotherapy; anti-tumor vaccine

DOI：

10.7507/1007-9424.202308008

Video：

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Objective To recognize the latest research progress of immunotherapy for advanced gastric cancer (AGC). Method The domestic and international literature on immunotherapy for AGC in recent years were retrieved and reviewed. Results The immunotherapy for AGC mainly focused on immune checkpoint inhibitors (ICIs), cellular immunity, and antitumor vaccines. The most immunotherapy researched was ICIs, especially for programmed death protein-1 / programmed death protein ligand 1, cytotoxic T lymphocyte associated antigen 4, and lymphocyte activating gene 3. The cellular immunotherapy and tumor vaccine therapy were less relatively. Although immunotherapy alone did not have a particularly good effect, its therapeutic effect was not inferior to that of chemotherapy alone and the incidence of adverse reactions was lower. Moreover, most studies had concluded that the use of immunotherapy in combination with other therapy had shown a good clinical efficacy, especially in combination with anti-human epidermal growth factor receptor 2 antibody, and chimeric antigen receptor T cells targeting Claudin 18.2 site had promising results in the AGC. Conclusions With the development of immunotherapy research, the strategies of immunotherapy for AGC are also constantly improving. Precision medicine is important in the process of immunotherapy. Targeted screening suitable patients and adopting precise treatment can further benefit the survival of patients with AGC.

Citation： MA Ganqing, LI Luyao, LIU Jixiang, DONG Na, FAN Ruifang. Advances in immunotherapy for advanced gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 9-15. doi: 10.7507/1007-9424.202308008 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Xu RH, Zhang Y, Pan H, et al. Efficacy and safety of weekly paclitaxel with or without ramucirumab as second-line therapy for the treatment of advanced gastric or gastroesophageal junction adenocarcinoma (RAINBOW-Asia): a randomised, multicentre, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol, 2021, 6(12): 1015-1024.
3.	Olson DJ, Eroglu Z, Brockstein B, et al. Pembrolizumab plus ipilimumab following anti-PD-1/L1 failure in melanoma. J Clin Oncol, 2021, 39(24): 2647-2655.
4.	Zhang F, Guo W, Zhou B, et al. Three-year follow-up of neoadjuvant programmed cell death protein-1 inhibitor (sintilimab) in NSCLC. J Thorac Oncol, 2022, 17(7): 909-920.
5.	Yu Y, Ma X, Zhang Y, et al. Changes in expression of multiple checkpoint molecules and infiltration of tumor immune cells after neoadjuvant chemotherapy in gastric cancer. J Cancer, 2019, 10(12): 2754-2763.
6.	Shitara K, Van Cutsem E, Bang YJ, et al. Efficacy and safety of pembrolizumab or pembrolizumab plus chemotherapy vs chemotherapy alone for patients with first-line, advanced gastric cancer: the KEYNOTE-062 phase 3 randomized clinical trial. JAMA Oncol, 2020, 6(10): 1571-1580.
7.	Chung HC, Kang YK, Chen Z, et al. Pembrolizumab versus paclitaxel for previously treated advanced gastric or gastro-esophageal junction cancer (KEYNOTE-063): a randomized, open-label, phase 3 trial in Asian patients. Cancer, 2022, 128(5): 995-1003.
8.	Fuchs CS, Özgüroğlu M, Bang YJ, et al. Pembrolizumab versus paclitaxel for previously treated PD-L1-positive advanced gastric or gastroesophageal junction cancer: 2-year update of the randomized phase 3 KEYNOTE-061 trial. Gastric Cancer, 2022, 25(1): 197-206.
9.	Moehler M, Dvorkin M, Boku N, et al. Phase Ⅲ trial of avelumab maintenance after first-line induction chemotherapy versus continuation of chemotherapy in patients with gastric cancers: results from JAVELIN gastric 100. J Clin Oncol, 2021, 39(9): 966-977.
10.	Wang F, Wei XL, Wang FH, et al. Safety, efficacy and tumor mutational burden as a biomarker of overall survival benefit in chemo-refractory gastric cancer treated with toripalimab, a PD-1 antibody in phase Ⅰb/Ⅱ clinical trial NCT02915432. Ann Oncol, 2019, 30(9): 1479-1486.
11.	Bang YJ, Kang YK, Catenacci DV, et al. Pembrolizumab alone or in combination with chemotherapy as first-line therapy for patients with advanced gastric or gastroesophageal junction adenocarcinoma: results from the phase Ⅱ nonrandomized KEYNOTE-059 study. Gastric Cancer, 2019, 22(4): 828-837.
12.	Kang YK, Chen LT, Ryu MH, et al. Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (ATTRACTION-4): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol, 2022, 23(2): 234-247.
13.	Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
14.	Xu J, Bai Y, Xu N, et al. Tislelizumab plus chemotherapy as first-line treatment for advanced esophageal squamous cell carcinoma and gastric/gastroesophageal junction adenocarcinoma. Clin Cancer Res, 2020, 26(17): 4542-4550.
15.	叶春, 王婷婷, 王晓欢, 等. 联合PD-1抑制剂在初始不可切除胃癌转化治疗中的临床疗效观察. 中国普外基础与临床杂志, 2023, 30(6): 728-731.
16.	Mori Y, Kataoka H, Ebi M, et al. Phase Ⅱ prospective study of trastuzumab in combination with S-1 and oxaliplatin (SOX100) therapy for HER2-positive advanced gastric cancer. J Gastrointest Cancer, 2022, 53(4): 930-938.
17.	Peng Z, Liu T, Wei J, et al. Efficacy and safety of a novel anti-HER2 therapeutic antibody RC48 in patients with HER2-overexpressing, locally advanced or metastatic gastric or gastroesophageal junction cancer: a single-arm phase Ⅱ study. Cancer Commun (Lond), 2021, 41(11): 1173-1182.
18.	Catenacci DV, Rosales M, Chung HC, et al. MAHOGANY: margetuximab combination in HER2+ unresectable/metastatic gastric/gastroesophageal junction adenocarcinoma. Future Oncol, 2021, 17(10): 1155-1164.
19.	Janjigian YY, Kawazoe A, Yañez P, et al. The KEYNOTE-811 trial of dual PD-1 and HER2 blockade in HER2-positive gastric cancer. Nature, 2021, 600(7890): 727-730.
20.	Herzog BH, Waqar SN, Devarakonda S, et al. Ramucirumab plus atezolizumab in patients with stage Ⅳ non-small cell lung cancer previously treated with immune checkpoint inhibitors. Lung Cancer, 2022, 173: 101-106.
21.	Nakajima TE, Kadowaki S, Minashi K, et al. Multicenter phase Ⅰ/Ⅱ study of nivolumab combined with paclitaxel plus ramucirumab as second-line treatment in patients with advanced gastric cancer. Clin Cancer Res, 2021, 27(4): 1029-1036.
22.	Zhang L, Wang W, Ge S, et al. Sintilimab plus apatinib and chemotherapy as second-/third-line treatment for advanced gastric or gastroesophageal junction adenocarcinoma: a prospective, single-arm, phase Ⅱ trial. BMC Cancer, 2023, 23(1): 211.
23.	Sahin U, Türeci Ö, Manikhas G, et al. FAST: a randomised phase Ⅱ study of zolbetuximab (IMAB362) plus EOX versus EOX alone for first-line treatment of advanced CLDN18. 2-positive gastric and gastro-oesophageal adenocarcinoma. Ann Oncol, 2021, 32(5): 609-619.
24.	Kwon M, Kim G, Kim R, et al. Phase Ⅱ study of ceralasertib (AZD6738) in combination with durvalumab in patients with advanced gastric cancer. J Immunother Cancer, 2022, 10(7): e005041.
25.	Somaiah N, Conley AP, Parra ER, et al. Durvalumab plus tremelimu-mab in advanced or metastatic soft tissue and bone sarcomas: a single-centre phase 2 trial. Lancet Oncol, 2022, 23(9): 1156-1166.
26.	Goldman JW, Dvorkin M, Chen Y, et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide versus platinum-etoposide alone in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): updated results from a randomised, controlled, open-label, phase 3 trial. Lancet Oncol, 2021, 22(1): 51-65.
27.	Shitara K, Ajani JA, Moehler M, et al. Nivolumab plus chemotherapy or ipilimumab in gastro-oesophageal cancer. Nature, 2022, 603(7903): 942-948.
28.	Kelly RJ, Lee J, Bang YJ, et al. Safety and efficacy of durvalumab and tremelimumab alone or in combination in patients with advanced gastric and gastroesophageal junction adenocarcinoma. Clin Cancer Res, 2020, 26(4): 846-854.
29.	Evrard C, Louvet C, Hajbi FE, et al. PRODIGE 59-DURIGAST trial: a randomised phase Ⅱ study evaluating FOLFIRI + Durvalumab ± Tremelimumab in second-line of patients with advanced gastric cancer. Dig Liver Dis, 2021, 53(4): 420-426.
30.	Tawbi HA, Schadendorf D, Lipson EJ, et al. Relatlimab and nivolumab versus nivolumab in untreated advanced melanoma. N Engl J Med, 2022, 386(1): 24-34.
31.	Shi YK, Luo SX, Zhou H, et al. Phase Ⅰ study of LBL-007, a novel anti-human lymphocyte activation gene 3 (LAG-3) antibody in patients with advanced solid tumors. J Clin Oncol, 2021, 39(15_suppl): 2523.
32.	Schuster SJ, Bishop MR, Tam CS, et al. Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma. N Engl J Med, 2019, 380(1): 45-56.
33.	Locke FL, Miklos DB, Jacobson CA, et al. Axicabtagene ciloleucel as second-line therapy for large B-cell lymphoma. N Engl J Med, 2022, 386(7): 640-654.
34.	Qi C, Gong J, Li J, et al. Claudin18.2—specific CAR T cells in gastrointestinal cancers: phase 1 trial interim results. Nat Med, 2022, 28(6): 1189-1198.
35.	Heczey A, Xu X, Courtney AN, et al. Anti-GD2 CAR-NKT cells in relapsed or refractory neuroblastoma: updated phase 1 trial interim results. Nat Med, 2023, 29(6): 1379-1388.
36.	Lee SC, Shimasaki N, Lim JSJ, et al. Phase Ⅰ trial of expanded, activated autologous NK-cell infusions with trastuzumab in patients with HER2-positive cancers. Clin Cancer Res, 2020, 26(17): 4494-4502.
37.	Wiedermann U, Garner-Spitzer E, Chao Y, et al. Clinical and immunologic responses to a B-cell epitope vaccine in patients with HER2/neu-overexpressing advanced gastric cancer—Results from phase Ⅰb trial IMU. ACS. 001. Clin Cancer Res, 2021, 27(13): 3649-3660.
38.	Fucikova J, Hensler M, Kasikova L, et al. An autologous dendritic cell vaccine promotes anticancer immunity in patients with ovarian cancer with low mutational burden and cold tumors. Clin Cancer Res, 2022, 28(14): 3053-3065.
39.	Zhang W, Lu X, Cui P, et al. Phase Ⅰ/Ⅱ clinical trial of a Wilms’ tumor 1-targeted dendritic cell vaccination-based immunotherapy in patients with advanced cancer. Cancer Immunol Immunother, 2019, 68(1): 121-130.
40.	Todo T, Ito H, Ino Y, et al. Intratumoral oncolytic herpes virus G47∆ for residual or recurrent glioblastoma: a phase 2 trial. Nat Med, 2022, 28(8): 1630-1639.
41.	Zhang B, Huang J, Tang J, et al. Intratumoral OH2, an oncolytic herpes simplex virus 2, in patients with advanced solid tumors: a multicenter, phase Ⅰ/Ⅱ clinical trial. J Immunother Cancer, 2021, 9(4): e002224. doi: 10.1136/jitc-2020-002224.
42.	Rojas LA, Sethna Z, Soares KC, et al. Personalized RNA neoantigen vaccines stimulate T cells in pancreatic cancer. Nature, 2023, 618(7963): 144-150.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Xu RH, Zhang Y, Pan H, et al. Efficacy and safety of weekly paclitaxel with or without ramucirumab as second-line therapy for the treatment of advanced gastric or gastroesophageal junction adenocarcinoma (RAINBOW-Asia): a randomised, multicentre, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol, 2021, 6(12): 1015-1024.
3. Olson DJ, Eroglu Z, Brockstein B, et al. Pembrolizumab plus ipilimumab following anti-PD-1/L1 failure in melanoma. J Clin Oncol, 2021, 39(24): 2647-2655.
4. Zhang F, Guo W, Zhou B, et al. Three-year follow-up of neoadjuvant programmed cell death protein-1 inhibitor (sintilimab) in NSCLC. J Thorac Oncol, 2022, 17(7): 909-920.
5. Yu Y, Ma X, Zhang Y, et al. Changes in expression of multiple checkpoint molecules and infiltration of tumor immune cells after neoadjuvant chemotherapy in gastric cancer. J Cancer, 2019, 10(12): 2754-2763.
6. Shitara K, Van Cutsem E, Bang YJ, et al. Efficacy and safety of pembrolizumab or pembrolizumab plus chemotherapy vs chemotherapy alone for patients with first-line, advanced gastric cancer: the KEYNOTE-062 phase 3 randomized clinical trial. JAMA Oncol, 2020, 6(10): 1571-1580.
7. Chung HC, Kang YK, Chen Z, et al. Pembrolizumab versus paclitaxel for previously treated advanced gastric or gastro-esophageal junction cancer (KEYNOTE-063): a randomized, open-label, phase 3 trial in Asian patients. Cancer, 2022, 128(5): 995-1003.
8. Fuchs CS, Özgüroğlu M, Bang YJ, et al. Pembrolizumab versus paclitaxel for previously treated PD-L1-positive advanced gastric or gastroesophageal junction cancer: 2-year update of the randomized phase 3 KEYNOTE-061 trial. Gastric Cancer, 2022, 25(1): 197-206.
9. Moehler M, Dvorkin M, Boku N, et al. Phase Ⅲ trial of avelumab maintenance after first-line induction chemotherapy versus continuation of chemotherapy in patients with gastric cancers: results from JAVELIN gastric 100. J Clin Oncol, 2021, 39(9): 966-977.
10. Wang F, Wei XL, Wang FH, et al. Safety, efficacy and tumor mutational burden as a biomarker of overall survival benefit in chemo-refractory gastric cancer treated with toripalimab, a PD-1 antibody in phase Ⅰb/Ⅱ clinical trial NCT02915432. Ann Oncol, 2019, 30(9): 1479-1486.
11. Bang YJ, Kang YK, Catenacci DV, et al. Pembrolizumab alone or in combination with chemotherapy as first-line therapy for patients with advanced gastric or gastroesophageal junction adenocarcinoma: results from the phase Ⅱ nonrandomized KEYNOTE-059 study. Gastric Cancer, 2019, 22(4): 828-837.
12. Kang YK, Chen LT, Ryu MH, et al. Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (ATTRACTION-4): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol, 2022, 23(2): 234-247.
13. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
14. Xu J, Bai Y, Xu N, et al. Tislelizumab plus chemotherapy as first-line treatment for advanced esophageal squamous cell carcinoma and gastric/gastroesophageal junction adenocarcinoma. Clin Cancer Res, 2020, 26(17): 4542-4550.
15. 叶春, 王婷婷, 王晓欢, 等. 联合PD-1抑制剂在初始不可切除胃癌转化治疗中的临床疗效观察. 中国普外基础与临床杂志, 2023, 30(6): 728-731.
16. Mori Y, Kataoka H, Ebi M, et al. Phase Ⅱ prospective study of trastuzumab in combination with S-1 and oxaliplatin (SOX100) therapy for HER2-positive advanced gastric cancer. J Gastrointest Cancer, 2022, 53(4): 930-938.
17. Peng Z, Liu T, Wei J, et al. Efficacy and safety of a novel anti-HER2 therapeutic antibody RC48 in patients with HER2-overexpressing, locally advanced or metastatic gastric or gastroesophageal junction cancer: a single-arm phase Ⅱ study. Cancer Commun (Lond), 2021, 41(11): 1173-1182.
18. Catenacci DV, Rosales M, Chung HC, et al. MAHOGANY: margetuximab combination in HER2+ unresectable/metastatic gastric/gastroesophageal junction adenocarcinoma. Future Oncol, 2021, 17(10): 1155-1164.
19. Janjigian YY, Kawazoe A, Yañez P, et al. The KEYNOTE-811 trial of dual PD-1 and HER2 blockade in HER2-positive gastric cancer. Nature, 2021, 600(7890): 727-730.
20. Herzog BH, Waqar SN, Devarakonda S, et al. Ramucirumab plus atezolizumab in patients with stage Ⅳ non-small cell lung cancer previously treated with immune checkpoint inhibitors. Lung Cancer, 2022, 173: 101-106.
21. Nakajima TE, Kadowaki S, Minashi K, et al. Multicenter phase Ⅰ/Ⅱ study of nivolumab combined with paclitaxel plus ramucirumab as second-line treatment in patients with advanced gastric cancer. Clin Cancer Res, 2021, 27(4): 1029-1036.
22. Zhang L, Wang W, Ge S, et al. Sintilimab plus apatinib and chemotherapy as second-/third-line treatment for advanced gastric or gastroesophageal junction adenocarcinoma: a prospective, single-arm, phase Ⅱ trial. BMC Cancer, 2023, 23(1): 211.
23. Sahin U, Türeci Ö, Manikhas G, et al. FAST: a randomised phase Ⅱ study of zolbetuximab (IMAB362) plus EOX versus EOX alone for first-line treatment of advanced CLDN18. 2-positive gastric and gastro-oesophageal adenocarcinoma. Ann Oncol, 2021, 32(5): 609-619.
24. Kwon M, Kim G, Kim R, et al. Phase Ⅱ study of ceralasertib (AZD6738) in combination with durvalumab in patients with advanced gastric cancer. J Immunother Cancer, 2022, 10(7): e005041.
25. Somaiah N, Conley AP, Parra ER, et al. Durvalumab plus tremelimu-mab in advanced or metastatic soft tissue and bone sarcomas: a single-centre phase 2 trial. Lancet Oncol, 2022, 23(9): 1156-1166.
26. Goldman JW, Dvorkin M, Chen Y, et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide versus platinum-etoposide alone in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): updated results from a randomised, controlled, open-label, phase 3 trial. Lancet Oncol, 2021, 22(1): 51-65.
27. Shitara K, Ajani JA, Moehler M, et al. Nivolumab plus chemotherapy or ipilimumab in gastro-oesophageal cancer. Nature, 2022, 603(7903): 942-948.
28. Kelly RJ, Lee J, Bang YJ, et al. Safety and efficacy of durvalumab and tremelimumab alone or in combination in patients with advanced gastric and gastroesophageal junction adenocarcinoma. Clin Cancer Res, 2020, 26(4): 846-854.
29. Evrard C, Louvet C, Hajbi FE, et al. PRODIGE 59-DURIGAST trial: a randomised phase Ⅱ study evaluating FOLFIRI + Durvalumab ± Tremelimumab in second-line of patients with advanced gastric cancer. Dig Liver Dis, 2021, 53(4): 420-426.
30. Tawbi HA, Schadendorf D, Lipson EJ, et al. Relatlimab and nivolumab versus nivolumab in untreated advanced melanoma. N Engl J Med, 2022, 386(1): 24-34.
31. Shi YK, Luo SX, Zhou H, et al. Phase Ⅰ study of LBL-007, a novel anti-human lymphocyte activation gene 3 (LAG-3) antibody in patients with advanced solid tumors. J Clin Oncol, 2021, 39(15_suppl): 2523.
32. Schuster SJ, Bishop MR, Tam CS, et al. Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma. N Engl J Med, 2019, 380(1): 45-56.
33. Locke FL, Miklos DB, Jacobson CA, et al. Axicabtagene ciloleucel as second-line therapy for large B-cell lymphoma. N Engl J Med, 2022, 386(7): 640-654.
34. Qi C, Gong J, Li J, et al. Claudin18.2—specific CAR T cells in gastrointestinal cancers: phase 1 trial interim results. Nat Med, 2022, 28(6): 1189-1198.
35. Heczey A, Xu X, Courtney AN, et al. Anti-GD2 CAR-NKT cells in relapsed or refractory neuroblastoma: updated phase 1 trial interim results. Nat Med, 2023, 29(6): 1379-1388.
36. Lee SC, Shimasaki N, Lim JSJ, et al. Phase Ⅰ trial of expanded, activated autologous NK-cell infusions with trastuzumab in patients with HER2-positive cancers. Clin Cancer Res, 2020, 26(17): 4494-4502.
37. Wiedermann U, Garner-Spitzer E, Chao Y, et al. Clinical and immunologic responses to a B-cell epitope vaccine in patients with HER2/neu-overexpressing advanced gastric cancer—Results from phase Ⅰb trial IMU. ACS. 001. Clin Cancer Res, 2021, 27(13): 3649-3660.
38. Fucikova J, Hensler M, Kasikova L, et al. An autologous dendritic cell vaccine promotes anticancer immunity in patients with ovarian cancer with low mutational burden and cold tumors. Clin Cancer Res, 2022, 28(14): 3053-3065.
39. Zhang W, Lu X, Cui P, et al. Phase Ⅰ/Ⅱ clinical trial of a Wilms’ tumor 1-targeted dendritic cell vaccination-based immunotherapy in patients with advanced cancer. Cancer Immunol Immunother, 2019, 68(1): 121-130.
40. Todo T, Ito H, Ino Y, et al. Intratumoral oncolytic herpes virus G47∆ for residual or recurrent glioblastoma: a phase 2 trial. Nat Med, 2022, 28(8): 1630-1639.
41. Zhang B, Huang J, Tang J, et al. Intratumoral OH2, an oncolytic herpes simplex virus 2, in patients with advanced solid tumors: a multicenter, phase Ⅰ/Ⅱ clinical trial. J Immunother Cancer, 2021, 9(4): e002224. doi: 10.1136/jitc-2020-002224.
42. Rojas LA, Sethna Z, Soares KC, et al. Personalized RNA neoantigen vaccines stimulate T cells in pancreatic cancer. Nature, 2023, 618(7963): 144-150.

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Advances in immunotherapy for advanced gastric cancer

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