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Review of combination strategies for digestive system tumors including gastric and colorectal cancer

Review of combination strategies for digestive system tumors including gastric and colorectal cancer
Photo by Elen Sher / Unsplash
Key Takeaway
Consider theoretical combination strategies for digestive system tumors, noting mechanisms remain incompletely understood.

This publication is a review that aims to offer a theoretical foundation and strategic directions to overcome clinical drug resistance and advance precision oncology. It covers a broad scope of digestive system tumors, specifically including gastric cancer, colorectal cancer, and hepatic malignancies. The text explores various intervention approaches such as immunochemotherapy, oncolytic virus, targeting of cancer stem cells, epigenetic modulation, and nanoparticle-based drug delivery systems alongside standard chemotherapy and immune checkpoint inhibitors. No specific sample size, setting, or follow-up duration was reported for these theoretical considerations.

The authors synthesize arguments regarding the potential of these combination strategies but emphasize that the underlying mechanisms remain incompletely understood. Consequently, the review does not provide pooled effect sizes or specific adverse event rates, as these details are not reported in the source material. The discussion focuses on the conceptual landscape of advancing therapeutic options rather than presenting data from a specific clinical trial.

Limitations acknowledged by the authors include the fact that strategies to further enhance the efficacy of combination therapies are still lacking. The review concludes that while these approaches provide a theoretical basis, their practical application requires further investigation. The practice relevance is framed as offering strategic directions rather than establishing new clinical guidelines based on definitive efficacy data.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
The prognosis for late-stage digestive system tumors is poor, largely due to the development of chemotherapy resistance. Although immunotherapy, particularly immune checkpoint inhibitors, has transformed the treatment landscape for some patients, strategies to further enhance the efficacy of combination therapies are still lacking, and the underlying mechanisms remain incompletely understood. To systematically address these therapeutic challenges and explore potential solutions, this review delineates the key mechanisms driving chemoresistance in digestive system tumors. It encompasses both cell-intrinsic mechanisms—such as enhanced drug efflux and DNA repair pathways—and extrinsic factors mediated by the tumor microenvironment (TME), including immune cell infiltration and metabolic reprogramming. A special emphasis is placed on the dual immunomodulatory roles of chemotherapy-induced immunogenic cell death (ICD) and its remodeling impact on the immune landscape. Given the considerable heterogeneity across digestive system cancers—including gastric, colorectal, and hepatic malignancies—the review also synthesizes recent advances in innovative combination strategies. These include immunochemotherapy, oncolytic virus, targeting of cancer stem cells (CSCs), epigenetic modulation, and nanoparticle-based drug delivery systems. Ultimately, this work aims to offer a theoretical foundation and strategic directions to overcome clinical drug resistance and advance precision oncology in digestive system tumors.
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