Gastric Cancer Treatment in China: Targeted Therapy, Immunotherapy, and the Coming World-First Solid Tumour CAR-T
China records approximately 40% of all gastric cancer diagnoses worldwide — more than 400,000 new cases annually — giving Chinese oncologists substantial institutional experience across all disease stages and treatment lines. For international patients, this depth translates into access to targeted therapies, immunotherapy regimens, HER2-directed treatments, and proximity to advanced Claudin18.2-targeted approaches currently in late-stage regulatory review globally.
Quick summary for patients
- China treats more gastric cancer patients annually than any country in the world, making this a uniquely experienced setting for second opinions and treatment.
- Biomarker testing — HER2, microsatellite instability (MSI), PD-L1, and Claudin18.2 — determines which treatments are most appropriate for each patient.
- China has developed several of its own innovative cancer drugs — including RC48 (an ADC) and multiple PD-1 inhibitors — that are approved in China and being studied globally.
- CT041, a China-developed CAR-T therapy targeting Claudin18.2, is in advanced regulatory review. If approved, it would be the world's first CAR-T approved for a solid tumour.
Why China's Gastric Cancer Caseload Matters
Gastric cancer incidence in East Asia — particularly China, Japan, and Korea — far exceeds that of Western countries, largely due to differences in dietary patterns, Helicobacter pylori prevalence, and screening practices. China alone accounts for roughly 40% of all global gastric cancer cases, translating to more than 400,000 new diagnoses and around 300,000 deaths each year.
At major oncology centres in Beijing and Shanghai, individual oncologists may manage several hundred gastric cancer patients per year — a volume that is unusual globally. This breadth of experience encompasses early-stage resectable disease, locally advanced disease with complex staging decisions, and heavily pretreated metastatic disease where third- and fourth-line treatment options are being evaluated.
For international patients whose gastric cancer treatment has progressed or stalled — or who want a structured expert review of their treatment plan — China's combination of caseload, trial access, and China-developed drugs represents a meaningful option to investigate.
Biomarker Testing: The Foundation of Modern Gastric Cancer Treatment
Before discussing specific drugs, it is important to understand that gastric cancer is not a single disease. Modern treatment is increasingly determined by the molecular profile of the tumour. In China, comprehensive biomarker testing at experienced centres typically evaluates:
An initial online MDT consultation can review existing pathology results and determine whether re-testing for newer biomarkers — particularly Claudin18.2 — is advisable before considering treatment options in China.
HER2-Targeted Therapy: An Expanding Toolkit
HER2-positive gastric cancer — accounting for roughly 15–20% of cases — has seen the most significant treatment advances over the past decade. China has access to both internationally established drugs and China-developed agents.
Trastuzumab (曲妥珠单抗 / 赫赛汀)
The original HER2-targeted antibody, approved globally and widely available in China. When combined with platinum-based chemotherapy, trastuzumab became the standard first-line treatment for HER2-positive advanced gastric cancer following the ToGA trial. It is available both as originator (Herceptin) and as biosimilar formulations within China's national reimbursement system.
Trastuzumab Deruxtecan (DS-8201 / 德曲妥珠单抗 / 赫赛莱)
An antibody-drug conjugate (ADC) that links trastuzumab to a topoisomerase I inhibitor payload. The DESTINY-Gastric01 trial demonstrated a significant survival benefit over standard chemotherapy in patients with HER2-positive gastric or gastroesophageal junction cancer after prior trastuzumab treatment. DS-8201 represents a major advance in the second-line setting and is approved in China.
RC48 — Disitamab Vedotin (维迪西妥单抗)China-developed
Developed by RemeGen (荣昌生物), RC48 is a China-developed HER2-targeted ADC approved by the NMPA for HER2-overexpressing gastric cancer. Importantly, RC48 has shown clinical activity not only in HER2-positive gastric cancer (IHC 3+) but also in patients with HER2 low or intermediate expression (IHC 2+/FISH-negative) — a population that would not qualify for trastuzumab or DS-8201 under current criteria. This potentially broader eligibility makes RC48 a meaningful option for patients who may not qualify for globally approved HER2-directed therapies.
Anti-Angiogenic Therapy: Cutting Off the Tumour's Blood Supply
Anti-angiogenic drugs target VEGFR (vascular endothelial growth factor receptor), blocking the formation of new blood vessels that tumours depend on for growth. In gastric cancer, this class of drugs is most commonly used in second-line or later settings.
Apatinib (阿帕替尼 / 艾坦)China-developed
Developed by Hengrui Medicine (恒瑞医药), apatinib is a VEGFR-2 inhibitor that was among the first targeted therapies specifically developed in China for gastric cancer. Approved by the NMPA for heavily pretreated advanced gastric or gastroesophageal junction cancer, apatinib demonstrated improved overall survival in a Phase III trial in this setting — a significant result given how limited third-line options are globally. It is widely used in China and is one of the most clinically studied China-developed cancer drugs.
Ramucirumab (雷莫芦单抗 / 赛兰泽)
An anti-VEGFR-2 antibody approved globally and available in China for second-line gastric and GEJ cancer, either alone or in combination with paclitaxel. The REGARD and RAINBOW trials established its efficacy in second-line disease. Ramucirumab is particularly relevant for patients progressing after first-line platinum- and fluoropyrimidine-containing chemotherapy.
Immunotherapy: PD-1 and PD-L1 Inhibitors — Including China-Developed Drugs
Immunotherapy using PD-1 or PD-L1 checkpoint inhibitors has become a central component of first-line treatment for gastric cancer, particularly when combined with chemotherapy. Response rates are highest in patients with MSI-H tumours and those with higher PD-L1 expression (CPS ≥5 or CPS ≥1).
China's large patient population has enabled unusually large immunotherapy trials in gastric cancer. Beyond internationally approved drugs, several China-developed PD-1 inhibitors have received NMPA approval based on robust Phase III data:
Nivolumab (纳武利尤单抗 / 欧狄沃)
The CheckMate 649 trial established nivolumab plus chemotherapy as a first-line standard of care for HER2-negative gastric and GEJ cancer with CPS ≥5. This approval is in force globally, including in China. Nivolumab is also approved as monotherapy in third-line settings based on Asian trial data.
Pembrolizumab (帕博利珠单抗 / 可瑞达)
Available in China for gastric cancer. The KEYNOTE-811 trial demonstrated the benefit of adding pembrolizumab to trastuzumab and chemotherapy for HER2-positive disease.
Sintilimab (信迪利单抗 / 达伯舒)China-developed
Developed by Innovent Biologics (信达生物), sintilimab is a PD-1 inhibitor approved by the NMPA for gastric and GEJ cancer. The ORIENT-16 trial — one of the largest randomised immunotherapy trials ever conducted in gastric cancer — showed significant overall survival improvement when sintilimab was added to chemotherapy in HER2-negative patients. Sintilimab pricing within China's national reimbursement system is substantially lower than originator drugs.
Serplulimab (斯鲁利单抗 / 择捷美)China-developed
Developed by Shanghai Henlius Biotech (上海复宏汉霖), serplulimab is a PD-1 inhibitor that received NMPA approval for first-line treatment of MSI-H solid tumours, which can include gastric cancer. For MSI-H gastric cancer — where immunotherapy responses are often most pronounced — serplulimab represents an accessible, domestically priced option within China.
The availability of multiple domestically approved PD-1 inhibitors at lower price points, combined with China's national insurance coverage, is one reason international patients from countries with limited drug access may find consulting in China valuable.
Considering gastric cancer treatment options in China?
An online MDT consultation with Chinese gastric cancer specialists can review your existing pathology, biomarker results, and treatment history — and outline whether targeted therapy, immunotherapy, or emerging options like Claudin18.2-directed treatment may be relevant.
Request an online MDT consultationClaudin18.2: The Target Reshaping Gastric Cancer — From Antibody to World-First Solid Tumour CAR-T
Of all the recent advances in gastric cancer treatment, perhaps none has generated more scientific and clinical attention than the targeting of Claudin18.2 (CLDN18.2). Understanding what this target is — and the two distinct therapeutic approaches being deployed against it — is important for patients exploring their options.
What is Claudin18.2?
Claudin18.2 is a protein found in the tight junctions of gastric mucosal cells — the cells lining the stomach. In healthy adults, its expression is essentially confined to the stomach. In gastric cancer and gastroesophageal junction (GEJ) cancer, Claudin18.2 is overexpressed on the surface of tumour cells in approximately 40–60% of patients at clinically meaningful levels. This selective expression makes it an attractive therapeutic target: treatments that recognise and attack CLDN18.2 can theoretically reach tumour cells without damaging most normal adult tissue.
Zolbetuximab (佐妥昔单抗) — The Anti-CLDN18.2 Antibody
Zolbetuximab is a monoclonal antibody that binds directly to CLDN18.2 on tumour cells, triggering immune-mediated tumour destruction. The Phase III SPOTLIGHT and GLOW trials demonstrated that adding zolbetuximab to standard first-line chemotherapy significantly extended progression-free and overall survival in CLDN18.2-positive, HER2-negative gastric and GEJ cancer. Zolbetuximab received FDA approval in the United States in 2024, making CLDN18.2 an established clinical target. The drug is being reviewed and studied in China as well, where large CLDN18.2 patient registries exist.
CT041 — The Claudin18.2 CAR-T Therapy
China-developed · Regulatory reviewPotential world-first solid tumour CAR-TCT041 is a CAR-T (chimeric antigen receptor T-cell) therapy developed by CARsgen Therapeutics (科济药业), a Shanghai-based biopharmaceutical company. Rather than using an antibody to target CLDN18.2 from the outside, CT041 engineers a patient's own immune T-cells to express a receptor that recognises and kills CLDN18.2-expressing cancer cells directly.
Phase I clinical data published in Nature Medicine showed objective tumour responses in a meaningful proportion of heavily pretreated gastric cancer patients who had failed multiple prior lines of therapy — a setting in which options are extremely limited globally. CARsgen has submitted CT041 for regulatory approval with China's National Medical Products Administration (NMPA).
Why this is globally significant: CAR-T cell therapy has transformed outcomes in blood cancers such as lymphoma, leukaemia, and multiple myeloma. However, making CAR-T work in solid tumours has been one of oncology's great challenges for over a decade. If CT041 receives NMPA approval, it would be the world's first approved CAR-T therapy for any solid tumour — a milestone comparable in significance to the first blood cancer CAR-T approvals of 2017–2018.
Regulatory approval is not yet confirmed. Eligibility requirements and clinical context will determine whether CT041 is appropriate for any individual patient.
For patients with CLDN18.2-positive gastric cancer considering their options, China is the most relevant geography to follow closely — both for CT041's regulatory progress and for access to CLDN18.2 testing and clinical trial enrolment. Read our detailed explainer on CT041 and the Claudin18.2 CAR-T breakthrough for more clinical detail, eligibility considerations, and logistics.
MDT Evaluation and Second Opinion
Gastric cancer treatment decisions — particularly around HER2 status, CLDN18.2 expression, and sequencing of targeted therapies and immunotherapy — are complex and benefit from multidisciplinary input. Major Chinese cancer centres conduct structured multidisciplinary team (MDT) case reviews bringing together medical oncologists, surgical oncologists, gastroenterologists, pathologists, and radiologists around each case.
For international patients, an online MDT consultation offers several practical benefits:
- Review of existing pathology and biomarker results — with recommendations on whether additional testing (including CLDN18.2 IHC) would be informative
- Staging and resectability assessment, including the potential role of perioperative chemotherapy
- Sequencing recommendations for targeted therapy, immunotherapy, and emerging agents
- Identification of open clinical trials in China for which the patient may be eligible
- Practical logistics guidance if in-person treatment in China is being considered
The CAR-T & Cell Therapy hub provides additional information for patients specifically investigating cell therapy options, including how access for international patients is coordinated.
Supportive and Palliative Care
High-volume oncology centres in China invest significantly in the infrastructure surrounding active cancer treatment. For gastric cancer patients — who often face nutritional challenges, gastrointestinal side effects from chemotherapy, and the sequelae of surgery — supportive care is an integral component of treatment at experienced centres.
Related Guides
CAR-T Cell Therapy for Solid Tumours: CT041 and the Claudin18.2 Breakthrough
A detailed look at CT041, the Claudin18.2 CAR-T therapy in late-stage regulatory review in China, and what it means for patients with gastric cancer.
Lung Cancer Treatment in China: Targeted Therapy & Immunotherapy
China's experience with EGFR, ALK, and other targeted therapies — plus China-developed PD-1 inhibitors — for lung cancer patients.
CAR-T Therapy in China: What Foreign Patients Should Know
How CAR-T access works for international patients in China, including logistics, costs, and eligibility considerations.
Frequently Asked Questions
Why do Chinese oncologists have so much experience with gastric cancer?
China accounts for approximately 40% of global gastric cancer cases, with more than 400,000 new diagnoses each year. This means leading Chinese cancer centres manage volumes of gastric cancer patients that few institutions worldwide can match. High caseload correlates with familiarity across all subtypes, stages, and treatment lines — including rare presentations and refractory disease.
What HER2-targeted drugs are available for gastric cancer in China?
Trastuzumab (曲妥珠单抗) combined with chemotherapy remains standard first-line treatment for HER2-positive gastric cancer. Trastuzumab deruxtecan (DS-8201, 德曲妥珠单抗) is available for HER2-positive disease after prior trastuzumab. RC48 (维迪西妥单抗), a China-developed HER2-targeted antibody-drug conjugate from RemeGen, is NMPA-approved for HER2-positive or HER2-overexpressing gastric cancer and has shown responses in patients who might not qualify for global approvals.
What is Claudin18.2 and why does it matter in gastric cancer?
Claudin18.2 (CLDN18.2) is a tight-junction protein expressed on the surface of many gastric cancer cells, but present in very limited quantities in normal adult non-gastric tissue. This selective expression makes it a potentially precise target: therapies directed at CLDN18.2 may attack cancer cells while sparing healthy tissue. Approximately 40–60% of gastric and gastroesophageal junction cancers express CLDN18.2 at clinically meaningful levels.
What is CT041 and could it be the first approved CAR-T for a solid tumour?
CT041 is a CLDN18.2-targeting CAR-T therapy developed by CARsgen Therapeutics (科济药业) in China. Phase I data published in Nature Medicine demonstrated objective responses in a meaningful proportion of heavily pretreated gastric cancer patients. CARsgen has filed for NMPA regulatory approval; if granted, CT041 would represent the world's first approved CAR-T cell therapy for a solid tumour. Regulatory approval is not yet confirmed, and clinical eligibility requirements will apply.
Can international patients access gastric cancer treatment at Chinese oncology centres?
Yes. Major comprehensive cancer centres in Beijing, Shanghai, and other cities accept international patients for gastric cancer evaluation and treatment. Pathology review, biomarker testing, MDT discussion, and treatment initiation can typically be coordinated for international patients. An initial online MDT consultation can help assess whether accessing care in China is appropriate for a specific clinical situation.
Medical disclaimer
This article is for informational purposes only and does not constitute medical advice. Drug availability, regulatory approvals, and clinical guidelines change over time. CT041 and other therapies described as being in regulatory review have not yet received final approval and are not currently available as standard treatments. Treatment decisions for gastric cancer should be made in consultation with qualified oncologists who have reviewed a patient's individual clinical situation, pathology, and medical history.
Explore gastric cancer treatment options in China
An online MDT consultation gives you structured access to Chinese gastric cancer specialists who can review your case, assess biomarker results, and outline what treatment options — including emerging Claudin18.2-directed therapies — may be relevant for your situation.
Request an online MDT consultationWe coordinate with leading gastric cancer oncologists at major Chinese cancer centres.