Dr. Janjigian on Immunotherapy Combinations in Gastric Cancer

Yelena Y. Janjigian, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses the addition of checkpoint inhibitors to the treatment landscape for patients with gastric and esophageal cancer, as well as potential combinations being investigated.

Data for checkpoint inhibitors has opened the field of immunotherapy in gastric cancer. Now that the field has made this leap, physicians are trying to understand how it fits with the other available treatments, says Janjigian. Since gastric cancer is a heterogeneous disease, it is hard to move from chemotherapy. It is still important in this algorithm, but there may be subgroups of patients that can move away from chemotherapy. For example, patients with microsatellite instability-high (MSI-H) patients, immunotherapy is a life-changer and has groundbreaking responses, Janjigian says.

For the majority of patients, the benefit of checkpoint inhibitors is minor, and the responses are not as deep or as durable. Pembrolizumab (Keytruda) is FDA approved for MSI-H tumors regardless of location, but for the majority of patients with gastric cancer, combination strategies will be the way forward, says J Janjigian. Combinations of immune checkpoint inhibitors with CTLA-4 or IDO inhibitors are currently being investigated.