Dr. Maron on the Role of PD-1 Inhibition in Esophagogastric Cancer

Steven Maron, MD, MSc, medical oncologist, Gastrointestinal Malignancies, Esophageal and Gastric Cancers, Targeted Therapies, Memorial Sloan Kettering Cancer Center, discusses the role of PD-1 inhibition in esophagogastric cancer.

After previously receiving FDA approvals for third-line treatment in esophagogastric cancer, pembrolizumab (Keytruda) and nivolumab (Opdivo) have both been approved in the first-line setting for metastatic disease; however, guidelines for the use of these agents remain murky,based on PD-L1 and mismatch repair status, Maron says. Additionally, adjuvant nivolumab has been approved for the treatment of patients with esophageal or gastroesophageal junction cancer who have received chemoradiotherapy followed by surgery, based on data from the phase 3 CheckMate-577 trial (NCT027434940), Maron explains.

Patients with gastric cancers tend to benefit more from PD-1–directed therapies than those with esophageal cancers, Maron continues. Additionally, patients with squamous cell cancers also receive a greater benefit from PD-1 inhibition, since patients with adenocarcinomas generally have low PD-L1 scores, Maron adds. Notably, current approvals exclude patients who receive perioperative chemotherapy who tend to have high PD-L1 scores and are more likely to be microsatellite instable, which is a considerable gap in esophagogastric cancer, Maron concludes.