Pembrolizumab for the treatment of gastric cancer

ABSTRACT

Introduction: Gastric cancer is one of a few gastrointestinal malignancies in which immunotherapy has shown meaningful activity. Pembrolizumab is the first and only immune checkpoint inhibitor to be FDA-approved in gastric cancer.

Areas Covered: This review summarizes the current and emerging clinical evidence for immune checkpoint inhibitors in advanced and metastatic gastric cancer, with a focus on pembrolizumab.

Expert Commentary: Pembrolizumab has shown impressive activity in the third-line treatment of locally advanced and metastatic gastric cancer. It is currently being studied as upfront therapy in combination with chemotherapy. The emerging understanding of the molecular alterations and tumor immune microenvironment as predictors of immunotherapy response in gastric cancer are discussed. The impact of gastric mucosal dysbiosis on gastric carcinogenesis and the modulation of immunotherapy response by the gut microbiome are also reviewed.

KEYWORDS:

• Gastric cancer
• pembrolizumab
• immunotherapy
• immuno-oncology
• microsatellite instability
• PD-L1
• PD-1

Declaration of interest

AB Benson has acted in a consulting or advisory role for Genentech/Roche, Bristol-Myers Squibb, Novartis, Celgene, Pfizer and AstraZeneca; has received fees for travel, accommodations and expenses from Genentech/Roche, Bristol-Myers Squibb and Sanofi, and has received research funding from Novartis, Bristol-Myers Squibb, Merck Sharp & Dohme, Celgene and MedImmune. 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.