Yelena Y. Janjigian, MD, Discusses Immunotherapy for Gastric Cancer

At the 2022 International Gastric Cancer Conference, Yelena Y. Janjigian, MD, chief of Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center, spoke with CancerNetwork® about using immunotherapy as first-line therapy to treat gastric cancer. She also discussed specific trials that, when read out, have the potential to impact the standard of care.

Transcript:

In terms of immunotherapy for gastric cancer, it really has transformed the field in the last 2 years. Several important studies resulted in [positive results in the] first-line metastatic setting, both in HER2-negative disease with the CheckMate 649 study [NCT02872116], and HER2-positive disease was KEYNOTE-811 study [NCT03615326].^1,2 We know that in stage IV disease, this treatment works. We also know that gastric cancer, in general at the time of resection, is at extremely high-risk for cancer recurrence in the systemic fashion, meaning outside of the initial resection location.

The truth is in gastric cancer and in the management of localized disease, many studies are ongoing, but [the results have not been read out]. The only time we use immunotherapy in localized disease is in resected esophageal or gastroesophageal junction [GEJ] adenocarcinoma, [which a sizeable] percentage of patients would fall into [this category] because in the [United States] and the Western population, true gastric cancers are relatively less common than GEJ proximal tumors. With those tumors, patients technically qualify for adjuvant nivolumab.³ Of course, there’s a caveat that the approval stands for patients who received prior chemo-radiation and then had surgery. We don’t tend to use radiation therapy in the United States for localized gastric cancer, and even some GEJ tumors likely do not need radiation therapy. That’s the caveat. There are many studies that are ongoing or finished and soon to be read out in localized gastric cancer with preoperative use of the combination of chemotherapy such as FLOT [flouracil, leucovorin, oxaliplatin, and docetaxel], or capecitabine/cisplatin in combination with immunotherapy. That’s the MATTERHORN study [NCT04592913] and the KEYNOTE-585 [NCT03221426] study; those will be reading out.

References

1. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet. 2021;398(10294):27-40. doi:10.1016/S0140-6736(21)00797-2

2. Janjigian YY, Kawazoe A, Yañez P, et al. The KEYNOTE-811 trial of dual PD-1 and HER2 blockade in HER2-positive gastric cancer. Nature. 2021;600(7890):727-730. doi:10.1038/s41586-021-04161-3

3. Opdivo. Prescribing information. Bristol Myers Squibb; 2014. Accessed March 3, 2022. https://bit.ly/3IHLkzO