Tailored Therapies Key for advanced gastric Cancer, New Research Suggests
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A new meta-analysis presented at the American Society of Clinical Oncology (ASCO) Gastrointestinal (GI) Cancers Symposium highlights the critical need for personalized treatment strategies in HER2-negative advanced gastric cancer, emphasizing the impact of metastatic sites adn Lauren subtype on patient outcomes. The research underscores both the benefits and limitations of combining chemotherapy with immune checkpoint inhibitors, urging clinicians to consider prompt referrals and clinical trial enrollment to improve survival rates.
Complexity of Gastric Cancer
“Chemotherapy plus immunotherapy has been the first-line treatment in standard settings,” explained a leading oncologist involved in the study. “However, we also know that gastric cancer is very heterogeneous, and there are different metastatic sites, including liver mass and bone mass. Then, also the habitat, and that is a peritoneal disease.”
The research team focused on analyzing the impact of peritoneal disease – cancer that has spread to the lining of the abdomen – versus cases without peritoneal involvement, and also the presence of liver mass. Interestingly, the analysis revealed that the difference in outcomes between patients with and without peritoneal disease was not statistically significant. However, patients with both liver mass and without liver mass demonstrated benefit from the chemotherapy and checkpoint inhibitor combination.
“This is also very engaging to us, because we know that immunotherapy and chemotherapy may not be able to significantly improve patients in this subgroup, so more studies are wanted,” the oncologist stated. “And then also we know there are ongoing locoregional treatments, such as HIPEC [hyperthermic intraperitoneal chemotherapy], hopefully in conjunction with those kinds of locoregional treatments, and we will improve patients with gastric cancer with peritoneal disease.”
Key Findings Highlight Tumor Microenvironment’s Role
The study’s key findings emphasize two crucial points. First, even within the category of metastatic gastric cancer, significant differences exist in subtypes, with the Lauren histology type playing a role in patient outcomes.Second, the location of metastasis influences the tumor microenvironment, directly impacting treatment response.
“Different metastasis means the tumor microenvironment plays a role in the patient’s outcome and the treatment response,” a researcher explained.
Implications for Clinical Practice and Future Research
These findings have significant implications for how physicians approach first-line treatment for HER2-negative advanced gastric cancer. While current NCCN [National Comprehensive Cancer Network] guidelines endorse chemo and immunotherapy, the research suggests a more nuanced approach is needed, particularly for patients with extensive peritoneal disease.
“Though, when you have extensive peritoneal disease, the first recommendation you may need to think about, besides chemo and immunotherapy, is that maybe you should refer this patient to a tier 3 and those top-tier academic centers for multidisciplinary programs,” the oncologist advised. “then there are some of the new innovations that can be conducted.”
The study also highlighted the need for further research comparing different immunotherapies – including tislelizumab, pembrolizumab, and nivolumab – to determine optimal treatment strategies. A direct comparison of these agents is needed to guide physician decision-making.
Ultimately, the research underscores the importance of open communication with patients, ensuring they understand the complexities of their diagnosis and the potential benefits and limitations of various treatment options. Given the historically poor prognosis for gastric cancer, early referrals for clinical trials are also crucial to explore innovative therapies and improve patient outcomes.
