Would you consider perioperative immunotherapy for a patient with locally advanced, resectable gastric cancer but not a candidate for chemotherapy?

Some aspects of the management in this situation are influenced by the surgical candidacy. If this patient is not a candidate for chemotherapy it would be critical to have a multidisciplinary assessment for surgical candidacy. Unfit for chemo but fit for surgery is a relatively uncommon clinical situation. Assuming this is truly the case the largest body of data is from the adjuvant trials.

Looking back at the Asian ACTS-GC (NEJM 2007) and CLASSIC trials (Lancet 2012) the control arms (surgery alone) had 3yr DFS rates of ~60% after an R0 D2 resection suggesting some patients with locally advanced disease can do well after good surgery alone. In US/European patients surgery alone has not performed nearly as well (roughly 30% 3yr DFS in INT-0...