How would you manage locally advanced, resectable gastric cancer that is MSI-H?

I would not recommend FLOT + durvalumab for MSI-H gastric/GEJ patients. I say this because there is mounting evidence that chemotherapy may not provide a significant benefit for these MSI-H patients at all (1). All efforts should be made to spare this patient population from getting cytotoxic chemot...

This is a very good question and lives in a largely "data-free zone" at this time. A recent meta-analysis shows that a number of small studies have been reported with an overall beneficial effect, including pCR (Schwengber et al., PMID 41687159). Based on our experience with rectal cancer (Cercek et...

This is a timely question, as I currently have several patients in this (highly favorable) situation.

What surprised me is the outcomes of these patients in MATTERHORN, as described in the published manuscript (Janjigian et al., PMID 40454643). As has been pointed out, there were only 25 patients wit...

To echo Dr. @Dr. First Last excellent commentary, I think this is a largely evidence-limited zone where decisions have to be patient-centered. Factors that I take into account in these discussions include patient performance status, co-morbid conditions, and the type of surgery that may need to be o...

Chemotherapy will likely add more toxicity than benefit. If PD1 monotherapy is not effective, can switch to dual; if dual is not working, would try NK-based immunotherapy.