Manish A Shah, MD, director, Gastrointestinal Oncology Program, Weill Cornell Medicine, chief, Solid Tumor Service, co-director, Center for Advanced Digestive Disease, NewYork-Presbyterian, discusses the importance of genetic testing in gastrointestinal (GI) cancer.

It is important to conduct genetic testing for patients with GI cancer as soon as they're diagnosed, Shah says. Lack of access to adequate tissue and the time needed for testing adds to the importance of testing as soon as possible, since treatments can vary depending on the presence of actionable biomarkers, Shah says.

HER2 testing is done by immunohistochemistry (IHC), and if a patient tests IHC 3+, they are considered HER2-positive, Shah notes. If a test returns as IHC 2+, then patients should receive a FISH test to confirm HER2 positivity, Shah explains. It is also important to test for mismatch repair deficiency, and if testing is done using a next-generation panel, patients should also receive microsatellite instability testing, Shah adds.

Furthermore, it is important to test for PD-L1 status by IHC, and a patient’s PD-L1 combined positive score can also aid treatment decisions, Shah continues. Notably, pembrolizumab (Keytruda) is approved for the treatment of patients with a tumor mutational burden (TMB) of 10 or higher, so evaluating that with testing is also critical, Shah concludes.

Videos

Manish A Shah, MD, discusses the importance of genetic testing in gastrointestinal cancer.


Dr. Shah on the Importance of Genetic Testing in GI Cancer

Data from the following clinical trials are discussed:

1382P - Phase 1b/2 open-label, randomized evaluation of second-line atezolizumab (atezo) + linagliptin (lina) vs ramucirumab (ram) + paclitaxel (pac) in MORPHEUS-gastric cancer (

 - CLDN 18.2-targeted CAR-T cell therapy in patients with cancers of the digestive system

LBA6 - KRYSTAL-1: Adagrasib (MRTX849) as monotherapy or combined with cetuximab (Cetux) in patients (Pts) with colorectal cancer (CRC) harboring a KRASG12C mutation 

Sam Klempner, MD; Daniel H. Ahn, DO; Nataliya V. Uboha, MD, PhD; and Manish A. Shah, MD, FASCO, review recent updates in second-line gastric cancer, CAR T-cell therapy in solid tumors, and colorectal cancer presented at ESMO 2021.

ESMO 2021 Updates in Gastric Cancer and Colorectal Cancer

LBA54 - Ipilimumab or FOLFOX in combination with nivolumab and trastuzumab in previously untreated HER2-positive locally advanced or metastatic esophagogastric adenocarcinoma (EGA): Results of the randomized phase 2 INTEGA trial (

LBA55 - Primary analysis of a phase 2 single-arm trial of trastuzumab deruxtecan (T-DXd) in western patients (Pts) with HER2-positive (HER2+) unresectable or metastatic gastric or gastroesophageal junction (GEJ) cancer who progressed on or after a trastuzumab-containing regimen (

Key opinion leaders in gastric cancers comment on ESMO 2021 updates in metastatic HER2+ esophagogastric adenocarcinoma and metastatic HER2+ gastric or gastroesophageal junction cancer.

ESMO 2021 Updates in HER2+  Metastatic Gastric and Gastroesophageal Cancer

LBA7 - Nivolumab (NIVO) plus chemotherapy (Chemo) or ipilimumab (IPI) vs chemo as first-line (1L) treatment for advanced gastric cancer/gastroesophageal junction cancer/esophageal adenocarcinoma (GC/GEJC/EAC): CheckMate 649 study (

LBA53 - Sintilimab plus chemotherapy (chemo) versus chemo as first-line treatment for advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma (ORIENT-16): First results of a randomized, double-blind, phase 3 study (

 - Neoadjuvant pembrolizumab in localized/locally advanced solid tumors with mismatch repair deficiency

Drs Sam Klempner, Nataliya V. Uboha, Daniel H. Ahn, and Manish A. Shah discuss recent data presented at ESMO 2021 for metastatic or locally advanced gastroesophageal and gastric adenocarcinomas.

ESMO 2021 Updates in Gastroesophageal and Gastric Adenocarcinomas

1373M0 - JUPITER-06: A randomized, double-blind, phase 3 study of toripalimab versus placebo in combination with first-line chemotherapy for treatment naive advanced or metastatic esophageal squamous cell carcinoma (ESCC) (

LBA52 - Sintilimab plus chemotherapy versus chemotherapy as first-line therapy in patients with advanced or metastatic esophageal squamous cell cancer: First results of the phase 3 ORIENT-15 study (

Experts in gastrointestinal cancers review recent updates and clinical implications from phase 3 trials presented at ESMO 2021 in metastatic esophageal squamous cell carcinoma (ESCC).

Manish A. Shah, MD, FASCO, Weill Cornell Medicine/New York-Presbyterian Hospital

Articles

Dr. Shah on the Importance of Genetic Testing in GI Cancer

ESMO 2021 Updates in Gastric Cancer and Colorectal Cancer

ESMO 2021 Updates in HER2+ Metastatic Gastric and Gastroesophageal Cancer

ESMO 2021 Updates in Gastroesophageal and Gastric Adenocarcinomas

ESMO 2021 Updates in Metastatic Esophageal Squamous Cell Carcinoma