Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses the findings of an analysis of nivolumab (Opdivo) in Asian (Eastern) versus Western patients with gastric/gastroesophageal junction (GEJ) cancer.

Investigators assessed the safety profile of nivolumab in an analysis of cohorts from the ATTRACTION-2 and CheckMate-032 trials to compare outcomes between Eastern and Western patients with gastric/GEJ cancer when treated with immunotherapy.

In terms of treatment-emergent adverse events (AEs), Chau says that events were similar in the cohorts compare from ATTRACTION-2 and CheckMate-032. Per the analysis, Eastern and Western patients seemed to have the same AEs while on nivolumab, although the etiology and outcome of gastric/GEJ cancer differs between the 2 groups. Chau says that the time to AEs and duration are worth comparing, as well.

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Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses the findings of an analysis of nivolumab (Opdivo) in Asian versus Western patients with gastric/gastroesophageal junction (GEJ) cancer.

Dr. Chau on Nivolumab in Asian Versus Western Patients With Gastric/GEJ Cancer

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses an analysis of Asian and Western patients with chemotherapy-refractory gastric/gastroesophageal junction (GEJ) cancer.

It is known that Eastern and Western patients with gastric/GEJ cancer are different in terms of etiology of the gastric cancer and the outcome. Asian patients with gastric/GEJ cancer seem to survive longer, and are diagnosed at an earlier stage, compared with Western populations, says Chau. This is due to these patients being younger with less comorbidities.

In an analysis of cohorts from the ATTRACTION-2 and CheckMate-032 trials, investigators described the safety profile of nivolumab (Opdivo) in Asian and Western patients who had received 2 or more prior lines of chemotherapy. This population included patients who received more than 1 dose of nivolumab at the data cutoff of August 2016 for ATTRACTION-2 and March 2016 for CheckMate-032. Investigators aimed to answer the question of difference in outcomes between Eastern and Western patients with gastric/GEJ cancer when treated with immunotherapy.

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses an analysis of Asian and Western patients with chemotherapy-refractory gastric/gastroesophageal junction (GEJ) cancer.
 

Dr. Chau on Analysis of Asian and Western Patients With Gastric/GEJ Cancer

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses findings with the combination of ramucirumab (Cyramza) plus pembrolizumab (Keytruda) in gastric or gastroesophageal (GEJ) cancer.

In a phase I study, 28 patients with treatment-naïve gastric or GEJ adenocarcinoma were administered ramucirumab at 8 mg/kg on days 1 and 8, and pembrolizumab at 200 mg on day 1 of week 3. Patients with both PD-L1—postive or –negative tumors were enrolled. PD-L1 status was assessed by DAKO PD-L1 22C3 IHC pharmDx assay, which established that 68% of the patients enrolled were PD-L1 positive.

Findings showed that 7 patients achieved an objective response, 6 who were positive for PD-L1 and 1 who was not. Additionally, median progression-free survival (PFS) was 5.3 months (95% CI 3.2-1.1). The median PFS observed in this study is comparable with first-line cytotoxic chemotherapy, but the combination regimen of ramucirumab plus pembrolizumab is better tolerated, Chau explains. Median overall survival has not yet been reached.

Chau acknowledges that since the majority of patients were PD-L1 positive, much of the positive response observed with this combination is attributed to that population.

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses finding with the combination of ramucirumab (Cyramza) plus pembrolizumab (Keytruda) in gastric or gastroesophageal (GEJ) cancer.
 

Dr. Chau on Findings of Ramucirumab Plus Pembrolizumab in Gastric/GEJ Cancer

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses the tolerability of ramucirumab (Cyramza) plus pembrolizumab (Keytruda) in gastric or gastroesophageal (GEJ) cancer.

In a phase I study of the combination of ramucirumab plus pembrolizumab in patients with treatment-naïve gastric or GEJ adenocarcinoma, safety and anti-tumor activity were evaluated. Ramucirumab was administered at 8 mg/kg on days 1 and 8, and pembrolizumab at 200 mg on day 1 of week 3. PD-L1 status was assessed by DAKO PD-L1 22C3 IHC pharmDx assay.

Of 28 patients, 7 achieved an objective response, 6 that were positive for PD-L1 and 1 that was not. Additionally, median progression-free survival was 5.3 months (95% CI 3.2-1.1). At the time of data presentation at the 2018 Gastrointestinal Cancers Symposium, median overall survival had not been reached.

This combination is very well tolerated, says Chau, with very few grade 3/4 toxicities, with the most common grade 3 toxicity being hypertension. Compared to standard cytotoxic chemotherapy where there is a high rate of grade 3/4 side effects, this is a well-tolerated combination for the treatment of patients with gastric or GEJ cancer, Chau concludes. This trial is currently ongoing.

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses the tolerability of ramucirumab (Cyramza) plus pembrolizumab (Keytruda) in gastric or gastroesophageal (GEJ) cancer.
 

Dr. Chau on the Tolerability of Ramucirumab Plus Pembrolizumab in Gastric/GEJ Cancer

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses the CheckMate 577 study in resected lower esophageal or gastroesophageal junction (GEJ) cancer.

CheckMate 577 is a randomized, double-blind, phase III study of nivolumab (Opdivo) in the adjuvant setting. Patients with stage I/II esophageal or GEJ cancer that have undergone preoperative chemoradiotherapy (CRT) are randomized to receive either nivolumab or placebo. This is due to the increase in expression of PD-L1 after CRT, says Chau, which has demonstrated survival benefits when combined with nivolumab.

This study is ongoing, with primary endpoints of overall survival and disease-free survival.

Dr. Chau on CheckMate577 Study in Esophageal/GEJ Cancer

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses interim safety and clinical activity results in patients with advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma from a multi-cohort phase I study of ramucirumab plus pembrolizumab (Keytruda).

Most of the patients participating in the study were heavily pre-treated, with the majority being treated in the third-line setting. The combination of ramucirumab plus pembrolizumab was very well tolerated, Chau says, with hardly any treatment-related grade 3 toxicities observed.

In terms of efficacy, though there are only short-term follow-up results as of now, 4 objectives responses were observed, which represents 10% of the patients. Though it may not seem like a high percentage, Chau says, many patients demonstrated prolonged disease stabilization.

At this time, investigators are still waiting for mature data for progression-free survival and overall survival. Those results will help determine how to move forward with future development of the ramucirumab/pembrolizumab combination.

Ian Chau, MD, consultant medical oncologist, Royal Marsden Hospital, discusses interim safety and clinical activity results in patients with advanced gastric or gastroesophageal junction adenocarcinoma from a multi-cohort phase I study of ramucirumab plus pembrolizumab.

Ian Chau, MD

Articles

Dr. Chau on Nivolumab in Asian Versus Western Patients With Gastric/GEJ Cancer

Dr. Chau on Analysis of Asian and Western Patients With Gastric/GEJ Cancer

Dr. Chau on Findings of Ramucirumab Plus Pembrolizumab in Gastric/GEJ Cancer

Dr. Chau on the Tolerability of Ramucirumab Plus Pembrolizumab in Gastric/GEJ Cancer

Dr. Chau on CheckMate577 Study in Esophageal/GEJ Cancer

Dr. Chau on Ramucirumab Plus Pembrolizumab for Gastric/GEJ Cancer