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...

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 for MRD ...