Daniel H. Ahn, DO
Although research in the field of gastric and gastroesophageal (GEJ) cancers is focusing on targeting CLDN18.2 and VEGF, Daniel Ahn, DO, explained that the area that has piqued everyone’s interest is immunotherapy.
State of the Science Summit™, Ahn discussed advances and challenges with targeted and immune-based therapies in the treatment of patients with gastric and GEJ cancer.
OncLive: What advancements have we seen in gastric/GEJ cancers?
A lot has changed in the way we treat gastric and GEJ cancers. We've had a lot of recent updates, in both the perioperative setting with the FLOT4 data and the metastatic setting with RAINFALL and JACOB. There are a lot of new emerging therapies specifically looking at targeting CLDN18.2, as well as looking at T-cell bispecific antibodies.
I would say there is a role for immune checkpoint inhibitors. The question is, “In what role of therapy?” Right now, immune checkpoint inhibitors are a relevant treatment in the refractory setting, specifically in PD-L1–positive patients in treating metastatic gastric or GEJ cancers. In patients who are PD-L1 negative or [low PD-L1 expression], we know that there is activity for pembrolizumab, but [there are] concerns for toxicities. There are also 2 negative phase III studies, so I would be very hesitant [to use it] right now, though it was still considered as a treatment option. I wouldn't move it into the second-line or earlier-stage setting. Other clinical trials are currently investigating that.
What targeted therapies are being investigated?
There are 3 relevant targets right now, including VEGF. There are positive data with using ramucirumab in the refractory setting. However, the positive data from the RAINFALL study did not manifest into clinical significance. The difference was about 0.3 months. In terms of its role in the first-line setting, ramucirumab should be avoided and primarily [used] in the refractory setting, so second-line setting or beyond—depending on what patients received in the first-line setting.
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