Dr Barzi on Unmet Needs in the Adjuvant Treatment of Gastroesophageal Cancers

Afsaneh Barzi, MD, PhD, director, AccessHope™, associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses unmet needs associated with the adjuvant treatment of patients with gastroesophageal cancers and highlights the use of nivolumab (Opdivo) in this setting.

Although there has been excitement following the implementation of new agents in the treatment of patients with metastatic gastroesophageal cancers in the scope of metastatic disease, there are currently no data confirming the benefit with immunotherapy agents in the adjuvant setting, Barzi begins. However, one exception to this unmet need is the data produced from the use of adjuvant nivolumab for patients who have had neoadjuvant chemoradiation or surgery with residual disease, and went on to receive nivolumab, Barzi explains. Treatment with adjuvant nivolumab in patients with resected esophageal or gastroesophageal junction cancer (GEJ) was evaluated in the phase 3 Checkmate 577 trial (NCT02743494), and led to the 2021 FDA approval of adjuvant nivolumab in resected esophageal or GEJ cancer.

Outside of this randomized, multicenter, double blind study of nivolumab, other completed trials have not met their primary end point with perioperative therapy or adjuvant therapy for gastric cancer, Barzi expands. Therefore, investigators cannot extrapolate these data and use these agents with curative intent outside of the patient populationin Checkmate 577, Barzi emphasizes, noting that this is important for oncologists to keep in mind when treating patients.

Although HER2-directed therapy has been an effective option for patients with metastatic disease fall into the metastatic setting, the trials that have been conducted in the early-stage setting have led to negative results thus far, Barzi says. Therefore, Based on this research and the outcomes that followed, these agents should be limited to use in the metastatic setting at this time, Barzi concludes.