Recent advances in immune-based approaches for the treatment of esophagogastric cancer

ABSTRACT

Introduction

The year 2021 will be remembered as a transformational year in the management of both esophageal and gastric cancers. Decades of failed clinical trials had seen limited therapeutic advances beyond refinement of the traditional combined modality approach. Targeted strategies against specific molecular alterations did not – with the exception of Her2 – yield the desired breakthroughs, and it was unclear what immune-based approaches would bring to this group of cancers. The presence of tumor-infiltrating lymphocytes in esophagogastric cancer demonstrates that an endogenous immune response is already occurring and potentially amplifiable by immune checkpoint inhibition. Recent data have validated this with FDA approvals in both the locoregional (CheckMate 577) and metastatic disease (CheckMate 649, KeyNote 590 and KeyNote 811) setting which have altered the therapeutic landscape.

Areas covered

Here we discuss recent data and ongoing research efforts to better define the role of immune-based approaches and select the patient cohorts who might gain the most benefit from them.

Expert opinion

Immunotherapy, and specifically the incorporation of the immune checkpoint inhibitors (ICI) drug class, has altered the therapeutic paradigm of many cancers in recent years. Anti-PD-1 therapies are now the new standard of care for patients with local and advanced disease.

KEYWORDS:

• Anti-PD-1
• esophageal cancer
• esophagogastric cancer
• Gastric cancer
• gastro-esophageal junction cancer
• immunotherapy

Declaration of interest

R Kelly is an advisory board member for Bristol-Myers Squibb, Merck, AstraZeneca, Daicchi Sankyo, Novartis, Eli Lilly, Takedo, EMD Serono, Eisai, Astellas, Ipsen and Phillips Healthcare; and has received research grants to his institution from Bristol Myers Squibb and Eli Lilly. A Duffy has received an educational grant from Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.