Dr Lizzy Smyth and Dr Sam Klempner share their views on practice-changing upper GI cancer data presented at the ESMO 2024 congress.
Watch and listen as the experts reveal what they consider to be the key takeaways and how the new data could impact clinical practice.
Clinical takeaways
- AGITG TOPGEAR: Results showed that the addition of pre-operative chemoradiotherapy to peri-operative chemotherapy does not improve long-term outcomes in patients with resectable gastric and gastro-oesophageal junction cancer. The trial results confirm that neoadjuvant chemoradiotherapy has no role in the treatment of operable gastric and gastroesophageal junction adenocarcinoma [Leong T, et al. Abstract LBA58, ESMO 2024 ]
- SPACE-FLOT: A retrospective dataset suggesting that pathological response to neoadjuvant FLOT predicts efficacy of adjuvant FLOT therapy. Interesting dataset, but randomised clinical trials required to confirm this finding [Lee M, et al. Abstract 1402MO, ESMO 2024]
- KEYNOTE-811: First-line treatment with the immunotherapy combination, pembrolizumab added to trastuzumab and chemotherapy (5-FU or CAPOX), significantly improves overall survival in HER2-positive metastatic gastric/ gastroesophageal junction adenocarcinoma [Janjigian Y, et al. Abstract 1400O, ESMO 2024 ]
- DESTINY-Gastric03: First-line T-DXd combinations with fluoropyrimidine and/or pembrolizumab demonstrated promising antitumour activity in metastatic HER2+ gastric cancer/gastroesophageal junction adenocarcinoma [Abstract 1401O. Janjigian Y, et al.]
- KEYNOTE-811 and DESTINY-GASTRIC03 show that pembrolizumab added to trastuzumab and chemotherapy is a suitable treatment option for patients who are both HER2-positive and PD-L1 positive and not for patients who are PD-L1 negative
- SHR-1701 in HER- patients: Trial showed that SHR-1701 (PD-L1/TGF-β bispecific) combined with CAPOX chemotherapy resulted in a significant OS benefit when used as first-line therapy for HER-2 negative gastric/gastroesophageal adenocarcinoma patients. China only study, so results not applicable outside China, also chemotherapy only control arm, so not clear what added benefit is over PD-1 alone [Peng Z, et al. Abstract LBA60, ESMO 2024]