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Esophagogastric Cancers: Integrating Immunotherapy Therapy Into Current Practice
Monica A Patel1,2, Jeremy D Kratz1,2, Sam J Lubner1,2
1Division of Hematology and Oncology, Department of Medicine, University of Wisconsin, Madison, WI.
Summary
Immune checkpoint inhibitors improve outcomes in esophagogastric cancers. Chemotherapy remains crucial, especially with PD-L1 positive tumors, while further research is needed for microsatellite unstable tumors and late-line treatments.
Area of Science:
- Oncology
- Immunotherapy
- Gastrointestinal Cancers
Background:
- Immune checkpoint inhibitors (IO) have transformed cancer treatment.
- Their role in esophagogastric cancers is increasingly established.
- Chemotherapy remains a cornerstone in treatment paradigms.
Purpose of the Study:
- To review the role of IO in early and advanced-stage esophagogastric cancers.
- To summarize evidence from key phase III trials.
- To identify ongoing challenges and future research directions.
Main Methods:
- Review of randomized phase III clinical trials.
- Analysis of data for adjuvant and first-line advanced settings.
- Consideration of biomarker status (PD-L1, MSI-H).
Main Results:
- Adjuvant nivolumab is approved for resected esophageal/gastroesophageal junction cancers post-chemoradiation (CheckMate 577).
- First-line IO plus chemotherapy recommended for PD-L1 positive advanced disease (KEYNOTE 590, CheckMate 649, 648).
- Chemotherapy is vital for eligible patients, including biomarker-selected ones.
Conclusions:
- IO is effective in specific settings for esophagogastric cancers.
- Further research is needed for microsatellite unstable tumors and late-line IO.
- Optimizing patient selection and combination strategies for IO is crucial.
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