Immunotherapy Is Beneficial For Gastric and Oesophageal Cancers

Immunotherapy is beneficial for patients with gastric and oesophageal cancers who currently have poor survival, shows a new data presented at ESMO 2020.

Immune therapy would bring a big change in treatment since immune checkpoint inhibitors are not yet approved for early therapy in Western countries. Three studies provide evidence, based on different patient populations and different immune checkpoint inhibitors used as first-line therapy.

‘Addition of nivolumab to chemotherapy becomes the standard of care for first-line treatment and it is found to improve the co-primary progression-free survival endpoint, but not overall survival.’

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CheckMate 649:

The CheckMate 649 trial (1) evaluated nivolumab and chemotherapy versus chemotherapy alone as first-line treatment in patients with non-HER-2-positive developed gastric cancer, gastro-oesophageal junction cancer, or oesophageal cancer, all with adenocarcinoma histology.

The results reveal that nivolumab and chemotherapy improve overall and progression-free survival in patients with PD-L1 combined positive score (CPS) greater than or equal to 5 tumors.

Stomach Cancer | Gastric Cancer
Stomach (gastric) cancer develops from the stomach lining. It is the third most common cause for cancer related deaths.

Improvements were also observed in patients with PD-L1 CPS greater than or equal to 1 tumor and in the overall patient population.

The results are clinically very relevant and reveal that nivolumab and chemotherapy improves overall and progression-free survival in patients with HER2-negative gastric adenocarcinoma, oesophagealgastro-oesophageal junctional adenocarcinoma with PD-L1 CPS greater than or equal to 5 tumors.

ATTRACTION 4:

The ATTRACTION 4 trial (2) was similar to CheckMate 649 except that it was performed only on Asian patients and the primary endpoints were designed for all-comers, rather than a specific CPS value.

“The improvement in progression-free survival was clinically relevant and the trial strongly supports the results of CheckMate 649,” said Al-Batran.

Overall survival was not improved because all-comers were treated or because patients in Asia receive more subsequent therapies than Western populations.

KEYNOTE 590:

The KEYNOTE 590 trial (3) examined first-line chemotherapy, with or without pembrolizumab, in patients with squamous cell carcinoma of the oesophagus, adenocarcinoma of the oesophagus, or Siewert type 1 gastro-oesophageal junction adenocarcinoma.

It revealed that pembrolizumab and chemotherapy improved overall survival in patients with squamous cell carcinoma of the oesophagus with PD-L1 CPS greater than or equal to 10 tumours, all squamous cell carcinomas, all patients with CPS greater than or equal to 10 and the study population as a whole. Progression-free survival was also improved.

“I expect that KEYNOTE-590 will change practice for patients with metastatic squamous cell carcinoma or adenocarcinoma of the oesophagus who have PD-L1 CPS greater than or equal to 10 tumors, for whom pembrolizumab added to chemotherapy will become the standard of care in the first-line, “ said Al-Bartan.

The results of these trials offer oncologists new treatment options. In the first-line setting, there is a clear change of our standard of care, in which patients with high PD-L1 expression will be candidates for immune checkpoint inhibitors plus chemotherapy. However, more data are needed on the subgroups to benefit from the treatment.

Source-Medindia