Dr. Smaglo on the Future of Immunotherapy in Gastric Cancer

Brandon G. Smaglo, MD, FACP, associate professor in the Department of Gastrointestinal Medical Oncology of the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the future of immunotherapy in gastric cancer.

Future directions in gastric cancer all come back to immunotherapy, says Smaglo. For example, full data from the phase 3 KEYNOTE-026 trial, which examined pembrolizumab as first-line treatment for patients with advanced gastric or gastroesophageal junction adenocarcinoma, are highly anticipated, says Smaglo.

Additionally, now that the field understands the scoring system better there are different ways in which that information can be applied to better utilize immunotherapy, which will be exciting, adds Smaglo. For example, unfortunately, the JAVELIN Gastric 100 data with avelumab (Bavencio) was a negative study. In that trial, investigators evaluated a maintenance approach with immunotherapy. Patients were started on chemotherapy to achieve initial cancer control and then they were switched to receive immunotherapy; that approach did not prove beneficial.

However, notably, that study did not examine the different biomarker data. It will be interesting to see in similar studies if there is a subset of patients with gastric cancer who would benefit from maintenance immunotherapy if a tumor biomarker like PD-L1 is present and potentially indicative of benefit, concludes Smaglo.