Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline

Abstract

PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)–negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .

Cost-effectiveness analysis of PD-1 inhibitors combined with chemotherapy as first-line therapy for advanced esophageal squamous-cell carcinoma in China

“…Standard fluoropyrimidine or paclitaxel plus cisplatin-based chemotherapy is recommended as first-line treatment for patients with advanced or metastatic ESCC (Muro et al, 2019). The clinical benefits, however, remain limited in patients with advanced or metastatic ESCC receiving standard of care, with a median overall survival (OS) of fewer than 1 year (Ajani et al, 2019;Shah et al, 2023). Therefore, discovering revolutionary treatment strategies to improve prognosis becomes a pressing need in these populations.…”

Evaluation of second-line apatinib plus irinotecan as a treatment for advanced gastric adenocarcinoma or gastroesophageal conjunction adenocarcinoma: a prospective, multicenter phase II trial

“…Moreover, there is a large proportion of GAC and GEJA patients with advanced disease at diagnosis who lose the opportunity for potentially curative surgical resection ( 7 , 8 ). According to the guidelines recommended by the Chinese Society of Clinical Oncology, the first-line systematic therapy for advanced GAC and GEJA is fluorouracil-based chemotherapy plus immunotherapy (combined with trastuzumab if the tumor presents human epidermal growth factor receptor 2 (HER2)-positive), while the second-line therapy is limited and merely includes paclitaxel, docetaxel, and irinotecan monotherapy or their combination, as well as paclitaxel and ramucirumab combination ( 9 , 10 ).…”

Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Q and A

“…The guideline includes recommendations for patients with advanced gastroesophageal adenocarcinoma or squamous cell carcinoma and for subgroups according to selected biomarkers. 1 This companion Q and A article addresses some of the questions that clinicians may face as they implement the recommendations into clinical practice. A summary of the recommendations are presented in Figure 1, and an algorithm is included in Figure 2.…”

“…The guideline includes recommendations for patients with advanced gastroesophageal adenocarcinoma or squamous cell carcinoma and for subgroups according to selected biomarkers. 1…”