Expert Think Tank: New Developments in Immunotherapy-Based Management of Gastric/GEJ Cancers Across the Disease Continuum

In your practice, which of the following patients with a gastroesophageal junction (GEJ) cancer would you recommend an immunotherapy-based perioperative regimen based on your understanding of which patients are most likely to benefit from this therapeutic approach?

A.
Patient with advanced gastric tumor with peritoneal metastases
B.
Patient with diffuse-type gastric adenocarcinoma
C.
Patient with mismatch repair–deficient (dMMR)/microsatellite instability (MSI)–high tumor
D.
Patient with low tumor mutational burden

Which of the following would you recommend for a patient with newly diagnosed, advanced gastric cancer and combined positive score (CPS) ≥5, HER2 1+, MSI ≥30%, and CLDN 18.2 staining <75% if prolonged survival is most important to the patient?

A.
Chemotherapy alone
B.
Chemotherapy plus an anti–PD-1 inhibitor (such as nivolumab)
C.
Chemotherapy, pembrolizumab, and trastuzumab
D.
Chemotherapy plus zolbetuximab

A 70-year-old male patient with newly diagnosed, metastatic GEJ cancer was prescribed chemotherapy plus a subcutaneous (SC) PD-1 inhibitor. He and his wife have questions about using the SC formulation and wonder whether the efficacy and adverse events (AEs) vary between IV and SC. His wife is a retired nurse, and she is asking whether she can administer the SC therapy at home.

How would you counsel them about SC immunotherapy compared with the IV formulation?

A.
The first SC injection is administered by a patient/caregiver in the home
B.
The SC injection can be administered in the thigh or abdomen
C.
Most patients develop antidrug antibodies (ADAs) with the SC formulation, causing reduced efficacy
D.
There are fewer AEs with SC compared with IV administration

The HERIZON-GEA01 trial for adults with unresectable locally advanced or metastatic HER2‑positive gastroesophageal adenocarcinoma, previously untreated in the advanced/metastatic setting, and not previously exposed to HER2‑targeted or PD‑1/PD‑L1–targeted therapies, showed which of the following results regarding tislelizumab and zanidatamab?

A.
It led to the approval of SC tislelizumab in combination with chemotherapy
B.
It led to the approval of tislelizumab and trastuzumab for patients with PD-L1 CPS ≥1 tumors
C.
It showed longer progression-free survival (PFS) with zanidatamab and tislelizumab chemotherapy than trastuzumab chemotherapy
D.
It did not meet the criteria for significance in median overall survival (mOS) comparing zanidatamab and tislelizumab chemotherapy with trastuzumab chemotherapy

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Expert Think Tank: New Developments in Immunotherapy-Based Management of Gastric/GEJ Cancers Across the Disease Continuum

Jaffer A. Ajani, MD

Activity

In your practice, which of the following patients with a gastroesophageal junction (GEJ) cancer would you recommend an immunotherapy-based perioperative regimen based on your understanding of which patients are most likely to benefit from this therapeutic approach?

Which of the following would you recommend for a patient with newly diagnosed, advanced gastric cancer and combined positive score (CPS) ≥5, HER2 1+, MSI ≥30%, and CLDN 18.2 staining <75% if prolonged survival is most important to the patient?

How would you counsel them about SC immunotherapy compared with the IV formulation?