Dr. Shah Discusses Challenges With Immunotherapy in Esophageal Cancer

Manish A. Shah, MD, director of gastrointestinal oncology and chief of Solid Tumor Service at Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses challenges with immunotherapy in esophageal cancer.

Modest activity has been observed with immunotherapy in patients with esophageal cancer. The FDA approved pembrolizumab (Keytruda) for the treatment of patients with PD-L1—positive recurrent or advanced gastric/gastroesophageal junction (GEJ) adenocarcinoma who have received 2 or more lines of chemotherapy in September 2017. Nivolumab (Opdivo) has also demonstrated strong clinical activity in patients with gastric and GEJ adenocarcinoma.

Shah says that although there has been success, the mechanism of resistance is still not known. It is unknown whether it could be increased regulatory T cells that are inhibitory, lack of antigen-presenting cells, or not enough cytotoxic T cells. More studies need to be done to understand what the mechanism of resistance is. Once that is accomplished, then immunotherapy can be augmented with another drug to overcome the resistance, or the mechanism or resistance can give an idea of how to better select patients, Shah says.