Barriers and Priorities for Immunotherapy Implementation in Advanced Gastric Cancer: Findings from a Two-Phase Qualitative Study

Background Immunotherapy has changed the therapeutic approach to advanced gastric cancer (AGC) and has shown survival benefits compared with standard chemotherapy. However, in clinical practice, its use remains heterogeneous. Differences in diagnostic pathways, organisational aspects, and regional settings may lead to delays in treatment access. This study aimed to analyse these issues and to describe possible shared strategies to improve the use of immunotherapy in AGC in Italy. Materials and Methods The analysis was performed in two steps. First, a focus group comprising 13 oncologists and pathologists from 5 national reference centres was organised to collect information on the use of immunotherapy biomarker tests and the main barriers encountered in daily practice. Based on the topics emerging from this discussion, a second step was conducted using a consensus questionnaire. The questionnaire was sent to a multidisciplinary group composed of 19 oncologists, pathologists, surgeons, pharmacists, and endoscopists. Results Several common problems were reported during the focus group discussion. These included delays in biomarker testing, differences in pre-analytical procedures among centres, the absence of shared quality indicators, and difficulties in tracking tissue samples, especially when samples were sent from outside hospitals. In addition, limited interaction among different specialists was frequently mentioned. The results of the questionnaire indicated a high level of agreement on several proposed actions, such as the evaluation of regional differences, the use of organisational models already adopted in some Italian oncology networks, the introduction of new biomarkers together with dedicated training activities, and the use of digital tools to support the discussion of complex cases. All survey items reached the predefined consensus threshold. Conclusions This study identified several organizational and diagnostic challenges affecting the implementation of immunotherapy in AGC. Participants highlighted a number of potential priorities for improvement, including optimization of diagnostic workflows, stronger multidisciplinary collaboration, and greater coordination across centres. These findings may inform future initiatives aimed at reducing variability in clinical practice and supporting equitable access to innovative treatments.