Table 2.

Recommended treatments of metastasis gastric cancer in United States and Japan.

	United States [83]	Japan [106]
First Line	HER2(+): Trastuzumab+ Fluoropyrimidine+ Cisplatin/Oxaliplatin HER2(-): ① Nivolumab + Fluoropyrimidine +Oxaliplatin (PD-L1 CPS of ≥5) ② Fluoropyrimidine + Oxaliplatin/Cisplatin. ③ Capecitabine + Oxaliplatin ④ Irinotecan + Fluorouracil ⑤ mDCF regimens (Docetaxel + Oxaliplatin + Calcium Folinate + Tegafur)	HER2(+): trastuzumab+ cisplatin+ capecitabine/S-1 HER2(-): ① S-1+ Cisplatin/Oxaliplatin ② Capecitabine + Cisplatin/Oxaliplatin ③ 5-FU + Levofolinate calcium + Oxaliplatin
Second Line	① Ramucirumab + Paclitaxel ② Fam-trastuzumab deruxtecan-nxki (for patients with HER2+ and had received prior trastuzumab-based therapy) ③ Monotherapy: Docetaxel, Paclitaxel, and Irinotecan ④ Irinotecan+Fluorouracil/Cisplatin/Ramucirumab/Docetaxel ⑤ Pembrolizumab (MSI-H/dMMR Tumors) ⑥ Ntrectinib/Larotrectinib (NTRK gene fusion-positive tumors)	Ramucirumab + Paclitaxel
Third Line	-	Nivolumab/Irinotecan