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Manish A. Shah, MD, discusses ongoing efforts to improve immunotherapy in gastric and gastroesophageal junction 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.