Checkpoint inhibitors in metastatic gastric and GEJ cancer: a multi-institutional retrospective analysis of real-world data in a Western cohort

Abstract

Background Safety and efficacy of immune checkpoint inhibitors in advanced gastric or gastroesophageal junction (GEJ) cancer could be demonstrated in predominantly Asian cohorts, whereas data in Western patients outside of clinical trials are vastly missing. Methods In this multi-institutional retrospective analysis conducted at nine oncologic centers in Austria, we tried to assess feasibility of checkpoint inhibitors in advanced gastric/GEJ cancer in a real-world Western cohort. Results In total, data from 50 patients with metastatic gastric/GEJ cancer who received nivolumab or pembrolizumab in a palliative setting between November 2015 and April 2020 have been evaluated. The median number of previous palliative therapy lines was two. The median progression-free survival (PFS) and overall survival (OS) were 2.1 (95% CI: 1.4–2.8) and 6.3 (95% CI: 3.3–9.3) months, respectively. There was no statistically significant difference in median OS according to microsatellite or PD-L1 status. However, a trend towards prolonged PFS and OS for the microsatellite instability high subgroup could be observed. Patients with an ECOG Performance Status (PS) ≥ 2 displayed a significantly worse outcome than those with an ECOG PS ≤ 1 (p = .03). Only one patient discontinued immunotherapy due to treatment-related toxicity. Conclusions Our results support feasibility of nivolumab and pembrolizumab in pre-treated patients with metastatic gastric and GEJ cancer in a Western real-world cohort. Further phase II/III studies are needed to confirm clinical efficacy.

Case Report: Complete Remission of a Patient With Metastatic Gastric Cancer Treated With Nivolumab Combined With Chemotherapy After Palliative Surgery

“…In this case, the tumor microsatellite has been stable, a different finding from most previous studies. Additionally, it has been demonstrated that microsatellite status had no significant effect on median progression-free survival (PFS) ( 35 , 39 , 40 ). The ECOG PS 1 in our case confirmed that the prognosis of patients with a PS of ≤1 is better than in those with a PS of ≥2 ( 40 ).…”

“…Additionally, it has been demonstrated that microsatellite status had no significant effect on median progression-free survival (PFS) ( 35 , 39 , 40 ). The ECOG PS 1 in our case confirmed that the prognosis of patients with a PS of ≤1 is better than in those with a PS of ≥2 ( 40 ). In contrast, it has been reported that for GC PD-L1-negative patients with high-efficiency mismatch repair (PMMR)/MSS and TMB-1, immune checkpoint blockade can also achieve good outcomes after systematic treatment failure ( 41 – 43 ).…”

Immunotherapy-Induced Vogt Koyanagi Harada Syndrome: A Case Report

“…In the recent years of checkpoint inhibitors, both pembrolizumab and nivolumab have also shown survival benefits in metastatic gastric carcinoma. Cytotoxic chemotherapy, combined with trastuzumab and pembrolizumab, is now recommended as the standard of care forfirst-line therapy formetastatic gastric carcinoma [2].…”

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“…Additionally, it has been demonstrated that microsatellite status had no significant effect on median progression-free survival (PFS) (35,39,40). The ECOG PS 1 in our case confirmed that the prognosis of patients with a PS of ≤1 is better than in those with a PS of ≥2 (40). In contrast, it has been reported that for GC PD-L1-negative patients with highefficiency mismatch repair (PMMR)/MSS and TMB-1, immune checkpoint blockade can also achieve good outcomes after systematic treatment failure (41)(42)(43).…”