ASTRUM-006 and the changing landscape of perioperative therapy for gastric cancer.

ASTRUM-006 provides phase 3 evidence that perioperative immune checkpoint inhibition improves event-free survival with Asian SOX-based chemotherapy in PD-L1-positive gastric cancer. Its postoperative chemotherapy-sparing strategy is attractive, although unmasking, event adjudication, and non-R0 or occult metastatic disease warrant consideration. The study nevertheless broadens the perioperative treatment framework and provides an important platform for refining patient selection and postoperative treatment intensity.