Immunotherapy of esophageal, GEJ and gastric tumors

Area of Science:

• Oncology
• Gastroenterology
• Immunotherapy

Background:

• Gastroesophageal cancers remain a significant cause of cancer mortality.
• Immunotherapy has emerged as a transformative treatment modality.

Purpose of the Study:

• To review the evolving treatment landscape for gastroesophageal cancers.
• To highlight the impact of recent clinical trial data, such as the MATTERHORN trial, on neoadjuvant and metastatic treatment strategies.

Main Methods:

• Review of current treatment guidelines and recent clinical trial findings.
• Analysis of molecular testing (PD-L1 CPS, TPS, HER2, MSI-H) for treatment selection.
• Discussion of immunotherapy combinations in metastatic settings.

Main Results:

• Adjuvant nivolumab is utilized in esophageal tumors.
• In metastatic disease, molecular profiling guides treatment decisions.
• Combinations of immunotherapy (nivolumab, pembrolizumab) with chemotherapy improve survival.
• Pembrolizumab plus trastuzumab and chemotherapy is a standard for HER2-positive cases (PD-L1 CPS ≥1).
• Immunotherapy is highly effective in MSI-H tumors, making adjuvant chemotherapy non-recommended.

Conclusions:

• Immunotherapy represents a paradigm shift in gastroesophageal cancer management.
• Personalized treatment strategies based on molecular markers are crucial.
• Future treatment paradigms, especially in the neoadjuvant setting, are likely to be shaped by ongoing research and clinical trials.