European-Australasian consensus on the management of advanced gastric and gastro-oesophageal junction cancer: current practice and new directions
Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9425884/
Gastric carcinoma and gastro-oesophageal junction (GC/GEJ) carcinoma remain a significant global problem, with patients presenting with symptoms often found to have advanced or metastatic disease. Treatment options for these patients have broadened in recent years with new chemotherapy agents, agents targeting angiogenic pathways and the development of immune checkpoint inhibitors (ICIs).
Conclusion/Relevance: In this review, we highlight the positive evidence from key trials that have led to our current practice algorithm, with particular focus on the refractory advanced disease setting, discussing the areas of active research and highlighting the factors, including biomarkers and the influence of ethnicity, that contribute to therapeutic decision-making.
• Source: Therapeutic Advances in Medical Oncology
• Conclusion: “In this review, we highlight the positive evidence from key trials that have led to our current practice algorithm, with particular focus on the refractory advanced disease setting, discussing the areas of active research and highlighting the factors, including biomarkers and the influence of ethnicity, that contribute to therapeutic decision-making.”
• This initial consensus was established among select members of the Australian Gastro-Intestinal Trials Group (AGITG) and ESMO Asia.
• With regard to first-line interventions, chemotherapy is the backbone of treatment for patients with gastric or gastroesopphageal junction (GEJ) cancer. Newer, targeted agents include trastuzumab in HER2-positive patients and immune-checkpoint inhibitors (ICIs) including nivolumab plus chemo in unselected patietns. Adding the ICI pembrolizumab to trastuzumab and chemotherapy holds promise, per the authors.
• Second-line therapy includes the antiangiogenic VEGFR-2 antagonist monoclonal antibody ramucirumab, which is effective either alone or in combination with paclitaxel. Notably, single-agent pembrolizumab is not superior to paclitaxel, based on trial data.
• The authors wrote, “Third-line therapy and beyond is a challenging area in patients with refractory advanced/metastatic GC/GEJ, due to high disease burden and less fit patients. Yet, many of the latest advances have been evaluated here with several now accepted as proven therapeutic options such as oral trifluridine/tipiracil chemotherapy, nivolumab in chemotherapy refractory patients and trastuzumab deruxtecan emerging as an option in HER2-positive patients. Small molecule antiangiogenic TKIs have also shown activity with apatinib showing efficacy in a phase III trial in China and the regorafenib in phase III development.”