Abstract: Gastric cancer is one of the most common malignancies in China. With the recent progress in drug therapy, the treatment of gastric cancer has entered the immune era. The results of the ATTRACTION-5 trial suggest selecting the optimal patient population for adjuvant immunotherapy after standard D2 gastrectomy. For locally advanced gastric cancer with microsatellite instability-high/mismatch repair deficiency (MSI-H/dMMR), sequential neoadjuvant therapy with double check point inhibitor treatment can achieve a pathological complete response (pCR) of 60%, warranting further exploration. Preliminary phase Ⅱ studies for perioperative treatmentof locally advanced gastric cancer suggest that immunotherapy combined with chemotherapy can achieve a higher pCR than perioperative chemotherapy alone, and this improvement positively correlates with the combined positive score (CPS). For HER2-positive locally advanced gastric cancer, a pCR of >30% can be achieved using targeted therapy combined with immunochemotherapy, which is significantly better than chemotherapy alone or chemotherapy plus targeted therapy. For locally advanced gastric cancer, immunotherapy combined with concurrent chemoradiotherapy can achieve a pCR of >40%, making it a promising treatment model for further exploration. Although the short-term effects of phase Ⅲ trials of neoadjuvant immunochemotherapy for locally advanced gastric cancer met expectations, the KEYNOTE-585 study did not meet the expectations for event-free survival (EFS) and overall survival (OS). The long-term results from the MATTERHONE and DRAGON Ⅳ trials are pending. CPS≥5 is recognized as a cutoff for benefiting from immunotherapy, whereas patients with CPS<1 are unlikely to benefit. For patients with stage Ⅳ gastric cancer, targeted therapy combined with immunochemotherapy for conversion therapy may result in a higher success rate of radical resection and postoperative pCR; however, a higher level of evidence-based medical evidence is needed.