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ESMO E-Learning: Advances in Gastro-Oesophageal Adenocarcinomas

Learning objectives

  1. To provide essentials in the molecular classification of gastro-oesophageal adenocarcinomas
  2. To provide an update in terms of treatment options for advanced gastro-oesophageal adenocarcinomas
  3. To provide an overview of recent clinical studies with immune checkpoint inhibitors for advanced gastro-oesophageal adenocarcinomas

Description

In this E-Learning module, the authors provide a comprehensive overview of molecular classification, treatment options and put into perspective recent advances in the management of advanced gastro-oesophageal adenocarcinomas. All sections in the modules are supported by evidence from relevant literature and clinical trials.

In the first part of the module, the authors elaborate the molecular characterisation of gastric and oesophageal adenocarcinomas from the pathology aspects and classification after gene expression, they also provide molecular classification according to the Cancer Genome Atlas.

In the second part of the module, the authors provide state of the art in terms of treatments for advanced disease, in particular the treatment options in first-, second-, and third-line settings.

The authors emphasise that HER2 status should be determined in all patients with advanced disease and trastuzumab should be added in case of HER2-positive tumours. Platinum-based chemotherapy is a first option, and FOLFIRI is an alternative. The authors state that second-line chemotherapy prolongs survival in patients with good performance status. Ramucirumab as single agent prolongs survival versus best supportive care (BSC). Ramucirumab in combination with paclitaxel improves outcomes over paclitaxel.

In the last part of the module the authors elaborate advances from clinical trials with immune checkpoint inhibitors and conclude that pembrolizumab and nivolumab are under development with interesting data to be confirmed. Nivolumab is superior to BSC in a placebo-controlled study. Pembrolizumab is not superior to weekly paclitaxel in second-line. Avelumab is not superior to third-line chemotherapy.

The authors also elaborate EBV and MSI as predictive factors to sensitivity for immune checkpoint inhibitors. They underline that understanding the mechanisms of primary resistance to immune checkpoint inhibitors will lead to precision immunotherapy in gastro-oesophageal adenocarcinomas.

Clinical studies with first-line immune checkpoint inhibitors are underway. The authors underline a need for better selection of patients in clinical trials, as well as for the validation of molecular classification in trials. International cooperation is key to make a further progress in this area.

This E-Learning module was published in 2019 and expired in 2021.

Last update: 02 Aug 2019

Prof Cervantes has reported the following:

Consultant or Advisory Role: Merck Serono, Roche, BeiGene, Bayer, Servier, Lilly, Novartis, Takeda, Astellas.

Research Funding: Genentech, Merck Serono, Roche, BeiGene, Bayer, Servier, Lilly, Novartis, Takeda, Astellas, FibroGen, Amcure, Sierra Oncology, Astra Zeneca, Medimmune, BMS, MSD

Speaking: Merck Serono, Roche, Amgen, Bayer, Servier, Foundation Medicine. Grant support:  Merck Serono, Roche.

Others: Executive Board member of ESMO, Chair of Education ESMO, General and Scientific Director INCLIVA, Associate Editor: Annals of Oncology and ESMO Open, Editor in chief: Cancer Treatment Reviews.

Dr Gambardella has reported no conflict of interest.

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