Dr. Shah on Optimal Sequencing in Gastroesophageal Cancer

Manish A. Shah, MD, Bartlett Family Associate Professor Gastrointestinal Oncology and associate professor of medicine at Weill Cornell Medical College and associate attending physician at NewYork-Presbyterian Hospital, discusses an optimal sequencing strategy in gastroesophageal cancer.

Findings from pivotal studies in this space have resulted in a clear sequencing strategy for patients with gastroesophageal cancer, explains Shah.

Patients with HER2-positive disease should receive chemotherapy in combination with trastuzumab (Herceptin) in the frontline setting.

There are some data suggesting that adding immunotherapy to first-line chemotherapy and trastuzumab may be superior to chemotherapy and trastuzumab alone, says Shah. However, that combination is still being investigated.

In the second-line setting, paclitaxel plus ramucirumab (Cyramza) is a common treatment regimen that does not require the presence of a specific target, says Shah.

Patients who are PD-L1­—positive and who have a combined positive score ≥1 should be considered for immunotherapy in the third-line setting, explains Shah.

In patients who are mismatch repair deficient, immunotherapy should be moved earlier into the second- or first-line settings, concludes Shah.