Dr. Shah on Improving the Benefit of Immunotherapy in Gastric/GEJ Cancer

Manish A. Shah, MD, Bartlett Family Associate Professor Gastrointestinal Oncology and associate professor of medicine at Weill Cornell Medical College and associate attending physician at NewYork-Presbyterian Hospital, discusses ongoing efforts to improve the benefit of immunotherapy in gastric and gastroesophageal junction (GEJ) cancer.

Immunotherapy has been shown to have efficacy in select patients with gastric/GEJ cancers, specifically those with PD-L1—positive tumors. Although high PD-L1 expression may increase the likelihood of benefit from immunotherapy, only about 10% to 15% of all PD-L1-expressing patients will respond to this approach.

Chemotherapy has demonstrated efficacy when given early on in the treatment of patients with advanced, symptomatic disease; however, long-duration chemotherapy can be associated with myelosuppression, says Shah.

To avoid myelosuppression, investigators are combining short-course chemotherapy with pembrolizumab (Keytruda) in patients with untreated gastric/GEJ cancer in the ongoing phase III KEYNOTE-585 trial. The role of radiation will also be investigated in this trial with intent to enhance immune response to immunotherapy, concludes Shah.