Comparing immunotherapies to other frequently used treatments of gastric cancer

ABSTRACT

Introduction: Although standard doublet chemotherapy represents the upfront gold standard to increase survival and improve quality of life of gastric cancer patients, overall improvements in long-term outcomes are modest and novel treatments are urgently needed. Among these, immunotherapy is an increasingly attractive option.

Areas covered: A number of clinical trials have shown that checkpoint inhibitors may be of value, but many unclear issues remain controversial and should be promptly untangled. In our short review, we offer the current available data regarding immunotherapies in gastric cancers, discuss potential limits of the reported trials, compare outcomes of checkpoints inhibitor to those of standard chemotherapy or other novel treatments, and present basic principles of immune surveillance and immune escape that may be embraced in the near future with novel drug combinations.

Expert opinion: Gastric cancer patients may benefit from immunotherapy, both given alone in advanced lines and upfront in combination with chemotherapy. We believe that appropriate patients’ and tumor’s selection are crucial issues to maximize its potential efficacy. In addition, we think that assay standardization, biomarker agreement, and translational studies will improve the benefit-to-risk ratio of these agents in the clinical practice.

KEYWORDS:

• Gastric cancer
• MSI-H
• EBV
• predictive biomarkers
• immunotherapy

Article highlights

• Overall improvement in long-term survival of GC by current treatment is modest.

• Outstanding results with immunotherapy have reshaped treatment of several cancers.

• Immunotherapy demonstrated promising results also in GC.

• The future efforts should better select pts that could benefit from immunotherapy.

Innovative clinical trials with combination strategy could represent a promising option.

Declaration of interest

G Aprile declares personal honoraria for lectures or advisory boards from Bristol Mayer Squibb, Servier, MSD, and Eli-Lilly. 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.