Dr. Smaglo on the Role of Immunotherapy in Advanced Gastric Cancer

Brandon G. Smaglo, MD, FACP, associate professor in the Department of Gastrointestinal Medical Oncology of the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the role of immunotherapy in advanced gastric cancer.

Immunotherapy has demonstrated utility in patients with gastric cancer whose tumors are microsatellite instable or PD-L1—positive, says Smaglo.

Although patients with any level of PD-L1 positivity are more likely to benefit from immunotherapy, early KEYNOTE studies revealed that a combined positive score (CPS) of 10 or greater could indicate improved response, explains Smaglo. Moreover, patients with higher CPS may benefit from checkpoint inhibitors such as pembrolizumab (Keytruda) in earlier lines of therapy.

The randomized, phase 3 KEYNOTE-062 trial showed that frontline pembrolizumab monotherapy elicited noninferior overall survival versus chemotherapy in patients with PD-L1—positive, HER2-negative, advanced gastric/gastroesophageal junction cancer.

These data highlight the need to test a patient’s PD-L1 status prior to starting treatment in order to optimize their response to treatment, concludes Smaglo.