Next stage of collaboration in East Asia gastric cancer treatment.

East Asia is a high-risk area for gastric cancer (GC). Despite the rapid progress of immunotherapy and target therapy in recent years, the median overall survival (OS) of metastatic GC is still no more than 2 years. Researchers from East Asia are active in GC clinical and molecular investigations. The collaboration of East Asia plays a vital role to further GC development. Cooperation across East Asia used to be led by Japan and South Korea. However, with the tremendous success of Chinese native drug research and development (R&D) in recent years, the new era calls for a next stage for future collaboration. With the abundance of patient resources and supportive policies from the government, China GC researches made breakthroughs in anti-human epidermal growth factor receptor 2 (HER2) drugs development and immunotherapy etc. Native programmed death 1 (PD-1) inhibitors demonstrated favorable outcomes in first-line GC treatment, early phase clinical trials also showed promising results in novel drug development in the scope of biomarker-guided precisive medicine. However, chances and challenges are both upfront to this special region. There is a lack of standardization in diagnostic and treatment protocols across Asian countries, which adds the difficulties in regional clinical trials. Poor developing countries in southeast Asia are unable to support high quality early phase clinical trials and translational studies, resource deficiency may be another challenge.