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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Transl Med. Nov 28, 2026; 12(4): 127329
Published online Nov 28, 2026. doi: 10.5528/wjtm.127329
Molecularly guided therapy in gastrointestinal malignancies: From established targets to resistance and emerging precision strategies
Himanshu Agrawal, Sahil Goel, Nikhil Gupta
Himanshu Agrawal, Department of Surgery, University College of Medical Sciences (University of Delhi), GTB Hospital, Delhi 110095, India
Sahil Goel, Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
Co-first authors: Himanshu Agrawal and Sahil Goel.
Co-corresponding authors: Himanshu Agrawal and Nikhil Gupta.
Author contributions: Agrawal H contributed to conceptualization, methodology, literature search and analysis, writing - original draft, writing - review and editing, supervision, and project administration; Goel S contributed to literature search and analysis, data curation, writing - original draft, and writing - review and editing; Gupta N contributed to literature search and analysis, data curation, and writing - review and editing. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Both Agrawal H and Gupta N have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Both Agrawal H and Goel S have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
AI contribution statement: Portions of this manuscript were edited and refined using ChatGPT (OpenAI) solely for language improvement, clarity, grammar, and organization. The authors independently reviewed, verified, and approved all AI-assisted content and take full responsibility for the accuracy, originality, scientific validity, and integrity of the manuscript. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Himanshu Agrawal, Associate Professor, Department of Surgery, University College of Medical Sciences (University of Delhi), GTB Hospital, Dilshad Garden, Delhi 110095, India. himagr1987@gmail.com
Received: August 27, 2026
Revised: September 21, 2026
Accepted: October 30, 2026
Published online: November 28, 2026
Processing time: 69 Days and 15 Hours
Core Tip

Core Tip: Molecularly targeted therapy has transformed the management of selected gastrointestinal malignancies by linking specific genomic or protein alterations to individualized treatment. This narrative review summarizes established and emerging molecular targets across colorectal, gastric and gastroesophageal junction, biliary, pancreatic, and gastrointestinal stromal tumors, while contextualizing therapies according to clinical evidence, biomarker requirements, and resistance mechanisms. Emerging approaches—including circulating tumor DNA, antibody–drug conjugates, bispecific antibodies, KRAS-directed therapies, and targeted–immunotherapy combinations—may help address treatment resistance, although their clinical roles vary in maturity and require continued prospective evaluation.

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