Lakshmi Rajdev, MD, director of GI Malignancies, Western Region for Northwell Health; chief of division for Hematology/Oncology, Department of Medicine, at Lenox Hill Hospital; and an associate professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, discusses the efficacy of pembrolizumab (Keytruda) plus chemotherapy in patients with esophageal cancer.

Results from the phase 3 KEYNOTE-590 trial (NCT03189719) demonstrated that the chemoimmunotherapy approach improved response rates, progression-free survival, and overall survival over chemotherapy alone in patients with advanced esophageal cancer, Rajdev says. These benefits were observed regardless of combined positive score (CPS), Rajdev adds. The patients who derived the greatest benefit from this approach were those with squamous cell carcinoma and a CPS of greater than 10, Rajdev notes.

Notably, 26% of patients on the study presented with adenocarcinoma, and approximately half of the patients had a CPS of 10 or greater, according to Rajdev. Considering the number of patients who had a CPS that was greater than or equal to 10, this regimen could potentially be applied to all patients with esophageal cancer, according to Rajdev. Although this regimen could represent a new standard of care, it remains to be seen how regulatory agencies will indicate who should receive this treatment, Rajdev concludes.

Videos

Lakshmi Rajdev, discusses the efficacy of pembrolizumab (Keytruda) plus chemotherapy in patients with esophageal cancer.


Dr. Rajdev on the Efficacy of Pembrolizumab/Chemotherapy in Esophageal Cancer

Lakshmi N. Rajdev, MD, an associate professor, Department of Medicine (Oncology), at Albert Einstein College of Medicine, Montefiore Medical Center, discusses the use of somatostatin analogs in patients with neuroendocrine tumors (NETs).

Somatostatin analogs have been shown to improve progression-free survival in patients with low-grade NETs. However, there is some debate as to the optimal timing to introduce these agents, says Rajdev. 

Patients with indolent disease could be monitored for extended periods of time without requiring treatment. If patients develop progressive or symptomatic disease, they could receive somatostatin analogs. Conversely, patients with a higher burden of disease could benefit from receiving these agents up front. 

Another area of debate is whether to continue somatostatin analogs when patients have disease progression. In the absence of robust data, discontinuing the drug in patients with progressive disease is advisable, says Rajdev. Notably, switching to another analog has not been shown to be beneficial in this setting. Conversely, if patients have hormone secretion or carcinoid syndrome, they can continue on these analogs since they’ve shown activity in carcinoid syndrome and hormonal syndrome management, concludes Rajdev.

Lakshmi N. Rajdev, MD, discusses the use of somatostatin analogs in patients with neuroendocrine tumors.

Dr. Rajdev on the Use of Somatostatin Analogs in Neuroendocrine Tumors

Lakshmi N. Rajdev, MD, an associate professor, Department of Medicine (Oncology), at Albert Einstein College of Medicine, Montefiore Medical Center, discusses the difference between cancers and carcinomas in patients with neuroendocrine tumors (NETs).

Patients with neuroendocrine cancers have a different course of treatment than those with neuroendocrine carcinomas, says Rajdev. Neuroendocrine carcinomas, particularly high-grade carcinomas, have an aggressive biology and could have large- or small-cell components. The disease is diagnosed as a carcinoma if there's ≥30% of a neuroendocrine component, as well as a carcinoma component, explains Rajdev.

Patients with these tumors should be treated with etoposide and carboplatin or cisplatin. Conversely, grade III neuroendocrine cancers are diagnosed in patients who have a Myotonic Dystrophy Health Index >24 high-power fields, or a Ki-67 of >20%. Neuroendocrine cancers are more indolent than high-grade carcinomas, adds Rajdev.

Generally, these patients are treated with traditional agents, such as everolimus (Afinitor). If the patient is symptomatic and has extensive bulky disease, capecitabine (Xeloda) and temozolomide (Temodar) could be used. Otherwise, these patients are treated the same way as those with low-grade NETs, concludes Rajdev.

Articles

Lakshmi N. Rajdev, MD, an associate professor, Department of Medicine (Oncology), at Albert Einstein College of Medicine, Montefiore Medical Center, discusses the difference between cancers and carcinomas in neuroendocrine tumors (NETs).

Lakshmi N. Rajdev, MD

Articles

Dr. Rajdev on the Efficacy of Pembrolizumab/Chemotherapy in Esophageal Cancer

Dr. Rajdev on the Use of Somatostatin Analogs in Neuroendocrine Tumors

Dr. Rajdev on the Difference Between Cancers and Carcinomas in NETs