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Despite innovations in diagnosis, most patients still present at advanced stages, contributing to a poor prognosis. For early gastric cancer, endoscopic resection or minimally invasive surgery has become standard, offering comparable oncologic outcomes with faster recovery compared with open surgery. In locally advanced disease, resection of the primary lesion and D2 lymphadenectomy, defined as dissection of lymph nodes along two levels of blood vessels supplying the stomach, remains the cornerstone of curative surgery, whereas perioperative chemotherapy, particularly oxaliplatin\u2010based regimens, has demonstrated improved survival benefits compared with surgery alone. The integration of immunotherapy into perioperative therapy for locally advanced disease and first\u2010line palliative therapy for metastatic disease represents a paradigm shift, with programmed death 1\/programmed death\u2010ligand 1 inhibitors combined with chemotherapy significantly improving pathologic complete response rates and overall survival, especially in programmed death ligand 1\u2013positive and microsatellite instability\u2010high tumors. Targeted agents include claudin 18.2 antibody, with zolbetuximab establishing a new first\u2010line standard for claudin 18.2\u2013positive disease, and antibody\u2013drug conjugates, such as trastuzumab deruxtecan for human epidermal growth factor receptor 2\u2013positive disease, both of which have revolutionized treatment paradigms. Emerging strategies include dual immune checkpoint inhibition, bispecific antibodies, chimeric antigen receptor T\u2010cell therapy, and fibroblast growth factor receptor 2b\u2013targeting agents. 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