Yelena Y. Janjigian, MD, is chief of the Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center.

Yelena Y. Janjigian, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses the role of immunotherapy for patients with gastric and esophageal cancer.

The Flatiron Health data puts the clinical significance of immunotherapy into context for the treatment of patients with metastatic gastric and esophageal cancer. The pooled analysis compared data and matched it to patient characteristics provided in the randomized phase III ATTRACTION-2 study in Asia investigating nivolumab (Opdivo) versus placebo.

The ATTRACTION-2 study demonstrated that nivolumab led to a reduction in the risk of death by 37% compared with placebo for patients with advanced gastric or gastroesophageal junction (GEJ) cancer following second or later-line chemotherapy. The median overall survival was 5.32 months (95% CI, 4.63-6.41) with nivolumab versus 4.14 months (95% CI, 3.42-4.86) in the placebo arm (HR, 0.63; 

In addition, the CheckMate-032 investigated nivolumab versus nivolumab and ipilimumab (Yervoy) in combination in this patient population.

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Dr. Janjigian on Immunotherapy in Esophageal and Gastric Cancer

Yelena Y. Janjigian, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses when to conduct microsatellite instability (MSI) testing for patients with gastric cancer.

According to Janjigian, it is important not to wait until the last line of therapy to know a patient’s MSI status. Although data suggests a patient’s MSI status may change as the patient progresses on several lines of therapy, if a patient is MSI-high (MSI-H), they have a better chance of responding to immunotherapy, explains Janjigian.

In 2017, the FDA granted an accelerated approval to pembrolizumab (Keytruda) for the treatment of adult and pediatric patients with unresectable or metastatic MSI-H or mismatch repair deficient (dMMR) solid tumors that have progressed after prior treatment and who have no satisfactory alternative treatment options.

The approval was based on data from 149 patients with MSI-H or dMMR cancers enrolled across 5 single-arm clinical trials. The objective response rate (ORR) with pembrolizumab was 39.6% (95% CI, 31.7-47.9), including 11 (7.4%) complete responses and 48 (32.2%) partial responses.

Dr. Janjigian on Conducting MSI Testing in Gastric Cancer

Yelena Y. Janjigian, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses testing for microsatellite instability (MSI) testing in patients with gastric cancer.

Though MSI-high is a relatively rare subset of gastric cancer, it is very important to distinguish these patients, says Janjigian.

MSI status must be routinely tested, Janjigian adds, because even if patients do not meet MSI criteria, a higher mutational burden may increase their chances of responding to therapy.

Dr. Janjigian Discusses MSI Testing in Gastric Cancer

Yelena Y. Janjigian, MD, assistant attending physician, Memorial Sloan Kettering Cancer Center, discusses results of an early-phase study looking at afatinib and cetuximab for patients with EGFR-mutant lung cancer.

This trial showed dramatic and durable responses in tumor shrinkage in patients with acquired resistant to erlotinib or gefitinib. Of those patients treated at the maximum tolerated dose, 29% experienced tumor regression — a substantial proportion of this group had tumor regression of greater than 50%, which typically translates to improvement in symptoms and quality of life.

Janjigian says that afatinib and cetuximab have overlapping toxicity profiles and that patients in this trial experienced diarrhea and rash.

Yelena Y. Janjigian, MD

Articles

Dr. Janjigian on Immunotherapy in Esophageal and Gastric Cancer

Dr. Janjigian on Conducting MSI Testing in Gastric Cancer

Dr. Janjigian Discusses MSI Testing in Gastric Cancer

Dr. Janjigian Discusses Afatinib and Cetuximab for Patients With EGFR-Mutant Lung Cancer