Dr. Mukherjee on Determining When to Initiate Immunotherapy in Gastroesophageal Cancer

Sarbajit Mukherjee, MD, MS, assistant professor of oncology, Department of Medicine, member, Tumor Immunology and Immunotherapy Program, Roswell Park Comprehensive Cancer Center, clinical assistant professor, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, discusses considerations to inform when to initiate immunotherapy in gastroesophageal cancer.

Now that several immunotherapeutic agents are approved for use in gastroesophageal cancer, the field is working to determine when immunotherapy should be initiated for patients, Mukherjee says.

On May 20, 2021, the FDA approved nivolumab (Opdivo) for patients with completely resected esophageal or gastroesophageal junction cancer with residual pathologic disease who have received neoadjuvant chemoradiation. The regulatory decision was based on findings from the phase 3 CheckMate 577 trial (NCT02743494), which demonstrated a statistically significant improvement in disease-free survival with nivolumab vs placebo in this patient population.

Notably, the approval of adjuvant nivolumab is not dependent on tumor histology or biomarker status, so patients with adenocarcinoma and squamous cell disease are eligible for this treatment irrespective of PD-L1 status, Mukherjee explains.

Other immunotherapeutic agents are included in the National Comprehensive Center Network (NCCN) guidelines as recommended frontline therapies in the metastatic setting. However, certain drugs are included in the NCCN guidelines with specific PD-L1 cutoffs. As such, this discordance complicates treatment selection with immunotherapy, Mukherjee concludes.