Abstract: Gastric cancer is one of the most highly malignant tumors in the world, especially in east Asia. More than 60% of patients are in advanced stages and heterogeneous at the time of initial diagnosis. Therefore, more accurate treatment plans are needed. At present, the lack of rapid and effective screening and verification platform is the bottleneck of precision medicine. The patient-derived tumor xenograft (PDX) model has proven to be an effective platform for studying tumor biology and evaluating the efficacy of anticancer drugs in various types of tumors. This article will review the research on PDX model in the individualized treatment of gastric cancer based on three levels: the evaluation of preclinical drug efficacy, the identification of biomarkers and studies on drug resistance mechanisms, and the human-rat co-clinical trials.