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Topics:
Gastrointestinal Cancers • Medical Oncology • Journal Club ft. NEJM publications • Gastric/GEJ Cancer
For patients with locally advanced GEJ adenocarcinoma with low PDL-1 score, will you still incorporate durvalumab with FLOT therapy?
The regimen is approved for all, but NCCN guidelines specify use primarily in PDL-1 >1%. Are you selecting treatment by PDL1 status?
Answer from: Medical Oncologist at Academic Institution
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...
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Answer from: Medical Oncologist at Academic Institution
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 ...
Answer from: Medical Oncologist at Academic Institution
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...