For patients with locally advanced GEJ adenocarcinoma with low PDL-1 score, will you still incorporate durvalumab with FLOT therapy?

Yes. I would still incorporate durvalumab with FLOT in patients with locally advanced GEJ adenocarcinoma even when PD-L1 expression is low. MATTERHORN was intentionally designed as an all-comers study without PD-L1 selection, and the event-free survival benefit was observed in the overall population...

This topic has been the subject of considerable debate. Although durvalumab has received FDA approval regardless of PD-L1 expression, our institutional practice includes routine assessment of PD-L1 status, and durvalumab is currently offered to patients with PD-L1 expression ≥1%.

In the MATTERHORN tr...

Yes. The primary analysis of MATTERHORN, as well as the updated analysis at ESMO 2025 (Tabernero et al., ESMO 2025) confirming an overall survival benefit for durvalumab/FLOT vs. FLOT, all show benefit irrespective of PD-L1 score. As such, the FDA approval of this regimen in November 2025 is irrespe...