Topics:
Gastrointestinal Cancers • Gastric Cancer • Esophageal Cancer • Medical Oncology • Immunotherapy
What initial systemic approach will you recommend for metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS of 0-4?
Do you view CPS < 1% or 1-4% separately? Do you view the incremental benefit of adding immunotherapy still advantageous given relatively poor outcomes with chemo alone in this disease?
Answer from: Medical Oncologist at Community Practice
In such patients, OS does not differ between chemotherapy alone and chemotherapy plus immunotherapy, therefore chemotherapy alone would be an appropriate choice. There is no difference in terms of OS benefit between CPS <1% or CPS 1 to 4%. The benefit that immunotherapy adds to chemotherapy is sl...
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Answer from: Medical Oncologist at Academic Institution
Based on the totality of the data, it is clear to me with increasing CPS scores, our ability to enrich for sensitivity to checkpoint inhibition increases. It is also clear, based on a large sample set, that the patients on CheckMate 649 with CPS < 5 did not have an improved survival with the addi...
Answer from: Medical Oncologist at Academic Institution
For a patient with a tumor that is PD-L1 CPS < 5, I would prescribe initial systemic therapy that ideally incorporates novel agents in the context of a clinical trial given the limitations of chemo alone in metastatic disease. On a case-by-case basis, I may add immunotherapy to chemotherapy in CP...