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Evolving Global Treatment Landscape for Gastric Cancer

Panelists: Johanna C. Bendell, MD, Sarah Cannon Research Institute; Peter C. Enzinger, MD, Dana-Farber Cancer Institute; Yelena Y. Janjigian, MD, Memorial Sloan Kettering Cancer Center; Kohei Shitara, MD, National Cancer Center Hospital East; Eric Van Cutsem, MD, PhD, University of Leuven
Published: Thursday, Sep 06, 2018



Transcript: 

Johanna C. Bendell, MD: Well, this has been a truly insightful discussion. Before we conclude, I’d like each of our panelists to provide a takeaway from this program. Dr. Enzinger, you have the floor.

Peter C. Enzinger, MD: I have the floor first. Well, certainly, I’ve enjoyed listening to my colleagues today and listening to their very insightful analyses of these various studies. I think that probably the most important take-home message I would take from these studies is that we’ve entered a new era where we’re really moving beyond cell cycle poisons, and we’re moving into an era where we’re adding immunotherapy. I think the early blush of excitement with immunotherapy probably is fading a little bit as we realize that these agents are not effective in the majority of our patients. Really, this is going to become a tool for a subset of patients. We ultimately need to figure out how to move this forward in a way where we can sustainably treat the majority of patients with this disease. I think that some of the ideas that were presented here certainly may improve the results that we currently have with the checkpoint inhibitors. We really need to think outside of the box, not just with the checkpoint inhibitor plus something else, and really think of other ways of manipulating the immune system.
But we really shouldn’t forget some of the other targeted therapies that are being developed. Again, I think that the fibroblast pathway will be important for some patients. MET I think was exciting a few years ago and then fell by the wayside. I think there are clearly a few patients that will respond to MET inhibition, and if we can find that group, that will be important. But, ultimately, I think this is going to require multiple combinations of various technologies to improve the outcome for our patients.

Johanna C. Bendell, MD: Dr. Janjigian?

Yelena Y. Janjigian, MD: I think the message has to be clear that gastric cancer is treatable, and there is hope, and there are a lot of new agents and options coming out every year, essentially. Even in my lifetime as an oncologist, we’ve had several drugs that became FDA approved. It is important to look for these rarer subsets, and even if you think it may not be the most urgent field to study, especially in the United States and Europe where it’s an orphan disease. Important cross-country and cross-continent collaborations answer some of these important questions and push the envelope; find a specialist, ask educated questions. There are subsets that we can cure potentially. We just need to find that 5%, 10% population and focus on small victories at a time.

Johanna C. Bendell, MD: Very true. Dr. Shitara?

Kohei Shitara, MD: Yes, gastric cancer is a very difficult disease to treat still because our KEYNOTE-061 trial showed a negative outcome as already discussed. But, clearly, some group of these patients achieve the remarkable benefit of this compound. So, gastric cancer is clearly a very heterogeneous disease. Intratumoral heterogeneity is also very important. I forgot to mention how we are studying DS-8201A, which shows very attractive activity for HER2-positive gastric cancer. This may overcome adverse effects. This kind of anti-drug conjugate compound may have a potential to be used for other targets. So, combining with these multimodality treatments, maybe we can improve the outcome of gastric cancer.

Johanna C. Bendell, MD: Very good. Dr. Van Cutsem, professor?

Eric Van Cutsem, MD, PhD: We should not forget that gastric cancer is still the second leading cause of cancer-related mortality, and that we have to tackle it with a global view. There are differences in the epidemiology. There are differences in therapeutic approaches. But if you look here at the panel with experts from different parts of the world, I think with collaboration that we can try, and that we really are able to make progress. We’ve had some disappointments, but we’ve had already some successes. I’m sure that if we can put the brains and the work of everybody together, that we can make further progress for our patients, and that gastric cancer should not anymore be the second leading cause of cancer-related mortality. That’s also an important take-home message on top of some of the scientific messages that were given by my colleagues.

Johanna C. Bendell, MD: Yes. Teamwork does make the dream work, right? It’s contrite but it’s true. Everybody coming together to do these studies on a global nature will change the future for our patients across the world. Thank you for all your contributions to this discussion. On behalf of our panel, we thank you for joining us and we hope you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity 

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Transcript: 

Johanna C. Bendell, MD: Well, this has been a truly insightful discussion. Before we conclude, I’d like each of our panelists to provide a takeaway from this program. Dr. Enzinger, you have the floor.

Peter C. Enzinger, MD: I have the floor first. Well, certainly, I’ve enjoyed listening to my colleagues today and listening to their very insightful analyses of these various studies. I think that probably the most important take-home message I would take from these studies is that we’ve entered a new era where we’re really moving beyond cell cycle poisons, and we’re moving into an era where we’re adding immunotherapy. I think the early blush of excitement with immunotherapy probably is fading a little bit as we realize that these agents are not effective in the majority of our patients. Really, this is going to become a tool for a subset of patients. We ultimately need to figure out how to move this forward in a way where we can sustainably treat the majority of patients with this disease. I think that some of the ideas that were presented here certainly may improve the results that we currently have with the checkpoint inhibitors. We really need to think outside of the box, not just with the checkpoint inhibitor plus something else, and really think of other ways of manipulating the immune system.
But we really shouldn’t forget some of the other targeted therapies that are being developed. Again, I think that the fibroblast pathway will be important for some patients. MET I think was exciting a few years ago and then fell by the wayside. I think there are clearly a few patients that will respond to MET inhibition, and if we can find that group, that will be important. But, ultimately, I think this is going to require multiple combinations of various technologies to improve the outcome for our patients.

Johanna C. Bendell, MD: Dr. Janjigian?

Yelena Y. Janjigian, MD: I think the message has to be clear that gastric cancer is treatable, and there is hope, and there are a lot of new agents and options coming out every year, essentially. Even in my lifetime as an oncologist, we’ve had several drugs that became FDA approved. It is important to look for these rarer subsets, and even if you think it may not be the most urgent field to study, especially in the United States and Europe where it’s an orphan disease. Important cross-country and cross-continent collaborations answer some of these important questions and push the envelope; find a specialist, ask educated questions. There are subsets that we can cure potentially. We just need to find that 5%, 10% population and focus on small victories at a time.

Johanna C. Bendell, MD: Very true. Dr. Shitara?

Kohei Shitara, MD: Yes, gastric cancer is a very difficult disease to treat still because our KEYNOTE-061 trial showed a negative outcome as already discussed. But, clearly, some group of these patients achieve the remarkable benefit of this compound. So, gastric cancer is clearly a very heterogeneous disease. Intratumoral heterogeneity is also very important. I forgot to mention how we are studying DS-8201A, which shows very attractive activity for HER2-positive gastric cancer. This may overcome adverse effects. This kind of anti-drug conjugate compound may have a potential to be used for other targets. So, combining with these multimodality treatments, maybe we can improve the outcome of gastric cancer.

Johanna C. Bendell, MD: Very good. Dr. Van Cutsem, professor?

Eric Van Cutsem, MD, PhD: We should not forget that gastric cancer is still the second leading cause of cancer-related mortality, and that we have to tackle it with a global view. There are differences in the epidemiology. There are differences in therapeutic approaches. But if you look here at the panel with experts from different parts of the world, I think with collaboration that we can try, and that we really are able to make progress. We’ve had some disappointments, but we’ve had already some successes. I’m sure that if we can put the brains and the work of everybody together, that we can make further progress for our patients, and that gastric cancer should not anymore be the second leading cause of cancer-related mortality. That’s also an important take-home message on top of some of the scientific messages that were given by my colleagues.

Johanna C. Bendell, MD: Yes. Teamwork does make the dream work, right? It’s contrite but it’s true. Everybody coming together to do these studies on a global nature will change the future for our patients across the world. Thank you for all your contributions to this discussion. On behalf of our panel, we thank you for joining us and we hope you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity 
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