Dr. Iqbal on Second- and Third-Line Therapies in Gastric Cancer

Syma Iqbal, MD, associate professor of clinical medicine, Keck School of Medicine, University of Southern California, discusses second- and third-line therapies in gastric cancer.

Physicians have a lot of options in the second-line setting, following the introduction of targeted therapies such as ramucirumab (Cyramza), says Iqbal. The VEGFR-2 inhibitor was FDA approved in 2014 as a treatment for patients with unresectable gastric cancer or gastroesophageal junction (GEJ) adenocarcinoma following fluoropyrimidine- or platinum-containing therapy. In 2017, the agent was tested in combination with cisplatin and capecitabine or 5-FU (5-fluorouracil) in the frontline setting but failed to improve overall survival in patients with HER2-negative metastatic gastric or GEJ adenocarcinoma.

Moreover, immunotherapy has made an impact in the field. Currently, pembrolizumab (Keytruda) is FDA approved in the third-line setting for patients who are PD—L1 positive. These patients have about a 15% response rate, adds Iqbal. Durability has been seen in some patients, though not commonly. The goal now, says Iqbal, is to move immunotherapy into the first- and second-line settings.