Topics:
Gastrointestinal Cancers • Gastric Cancer • Esophageal Cancer • Medical Oncology • Gastroesophageal Cancer • Journal Club ft. NEJM publications
Should we be giving adjuvant nivolumab to all eligible esophageal/GEJ cancer, irrespective of the PD-L1 status of the tumor?
Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data sets? Would the HER2 status of the residual disease affect your decision?
Answer from: Medical Oncologist at Academic Institution
The FDA approval is regardless of PD-L1 expression. We did not see tumor cell PD-L1 (TPS) enriching for DFS benefit. In a post-hoc exploratory analysis published in the supplementary appendix (S2) of NEJM publication, we evaluated DFS in patients with PD-L1 combined positive score (CPS) >5 compar...
Sign in or Register to read more
Answer from: Medical Oncologist at Academic Institution
For many years, a major whole in the arsenal for treatment of esophageal and gastroesophageal junctional cancer was the lack of evidence for adjuvant therapy following neoadjuvant chemoradiation and esophagectomy. At GI Oncology tumor boards, we’d frequently hear challenging cases of esophagea...
Answer from: Medical Oncologist at Academic Institution
Yes, the CM 577 trial showed benefit across subgroups by tumor PDL1 status (tumor PDL1 expression < 1% or >= 1%). Thus, I would not use PDL1 status in the decision making for adjuvant nivolumab. Moreover, if PDL1 status is to be checked in esophageal and GE jxn cancer, CPS score (rather than t...