![]() ![]() These treatment advances have greatly expanded the treatment landscape. Tumor histology remains a critical factor in decision-making biomarker testing for HER2 is performed only on adenocarcinomas, whereas drug selection for a given line of therapy for squamous cell carcinoma and adenocarcinoma may differ based on PD-L1 expression levels, she said. Because these malignancies are now being categorized according to HER2 status, microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) status, and PD-L1 expression, biomarker testing is a necessary first step at diagnosis to facilitate treatment management across the therapy continuum. Matkowskyj, MD, PhD, Associate Professor in the Department of Pathology and Laboratory Medicine and Director of the UW Carbone Cancer Center Translational Sciences BioCore. Lurie Comprehensive Cancer Center of Northwestern University, at the NCCN 2021 Virtual Annual Conference.įurthermore, the growing importance of biomarkers in these cancers was emphasized by Kristina A. ![]() Mulcahy, MD, Professor, Department of Hematology-Oncology, Northwestern University, and Director, Gastrointestinal Oncology Program, Robert H. Denlinger, MD, Chief, Division of Gastrointestinal Medical Oncology, and Co-Director, Survivorship Program, and Associate Professor, Department of Hematology-Oncology, Fox Chase Cancer Center, and Mary F. Trials supporting the use of these improved therapies, and their application in the clinic for certain subgroups, was presented by Crystal S. These new drugs include immune checkpoint inhibitors (ICIs), the HER2-directed agent trastuzumab-deruxtecan (T-DXd), the monoclonal antibody ramucirumab, and the cytotoxic agent trifluridine/tipiracil. ICIs are now moving into the adjuvant setting as well, and a new recommendation is nivolumab use after preoperative chemoradiation and surgery in patients who have residual disease identified at the time of their R0 resections.įor the treatment of gastric and esophageal cancers, recent studies have demonstrated robust findings for new drugs that, as a consequence, are becoming FDA-approved and added to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Esophageal and Esophagogastric Junction Cancers and for Gastric Cancer. T-DXd is another new second-line option for HER2-positive esophageal, GEJ, and gastric adenocarcinomas. Recently, ICIs have been incorporated into the first-line treatment of HER2-negative advanced esophageal, gastroesophageal junction (GEJ), and gastric cancers, in addition to second-line treatment of advanced esophageal and GEJ cancer of squamous histology. These agents convey varying degrees of benefit depending on treatment line, PD-L1 expression, HER2 expression, and tumor histology. In addition to pembrolizumab and nivolumab, new treatment options include trastuzumab-deruxtecan (T-DXd), ramucirumab, and trifluridine/tipiracil. For the treatment of gastric and esophageal cancers, several pivotal trials-especially those evaluating immune checkpoint inhibitors (ICIs)-have altered the treatment landscape and led to changes in the NCCN Guidelines.
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