What adjuvant treatment approach would you recommend for a patient with early-stage MSI-high gastric cancer who received neoadjuvant ipilimumab (×2) and nivolumab (×6) per the NEONIPIGA regimen, followed by R0 resection with no pathologic response?  

I would favor FOLFOX x6 as per classic. This scenario raises the question: Was this truly MSI-H? I would confirm MSI status with next-gen sequencing. I would have expected a response if MSIH on ngs with concomitant high TMB. Our institutional practice has been to review all MSI-H IHC cases done outs...

If there was indeed no evidence of response to pre-surgery immunotherapy, then we can consider adjuvant CAPOX or FOLFOX for 6 months. Assuming that upStage is high and it is node positive (meaning high risk of relapse).

We have no information on the need for further therapy. These patients appear to do better than MSS patients treated with surgery and adjuvant therapy. I would check a ctDNA test and observe if negative. If positive, that’s a discussion with the patient. Data do not exist that early therapy fo...