ESMO E-Learning: First Line Immunotherapy for Oesophageal and Gastric Cancer as New Standard of Care

In this E-Learning module, the authors describe tumour features characteristics for gastro-oesophageal adenocarcinoma and squamous oesophageal cancer, immune characteristics of gastro-oesophageal adenocarcinoma and squamous oesophageal cancer. They summarise and put into clinical context the results from the studies that have recently changed the clinical practice, and provide an overview of clinical studies in progress in the peri-operative setting.

The authors emphasise that the tumour biology and the tumour immune microenvironment have an impact on the therapeutical response. They underline a new standard of care in the adjuvant setting, with immunotherapy for high-risk oesophageal and gastro-oesophageal junction adenocarcinoma, as well as chemo-immunotherapy in the first-line setting for gastro-oeshophageal adenocarcinoma with combined positive score [CPS] ≥5 and CPS≥10 in squamous cell carcinoma. They also elaborate outstanding questions, such as immune checkpoint inhibitor combinations in the peri-operative setting, new combination strategies and new biomarkers.

Through the illustration of the key tumour features and the tumour immune microenvironment shaping cancer biology and impacting on the responsiveness to therapy, the authors present findings from the clinical study of adjuvant immunotherapy for oesophageal cancer not achieving optimal remission after adjuvant chemo-radiotherapy; ongoing immunotherapy trials for localised gastro-oesophageal adenocarcinoma; key clinical studies with immune checkpoint inhibitors for advanced oeophageal squamous cell carcinoma in second- and further lines; immunotherapy in first-line for advanced oesophageal and gastro-oesophageal junction tumours; immune checkpoint inhibitors for second-line or further in gastro-oesophageal adenocarcinoma, and consider whether there is a difference in the response to immune checkpoint blockade between Asian and non-Asian populations.

A significant part of the module is dedicated to the assessment of biomarkers for immune checkpoint inhibitors in gastro-oesophageal cancer, biomarker analysis from clinical studies based on PD-L1 CPS score, the impact of MSI status on immunotherapy for oesophageal, gastro-oesophageal junction and gastric adenocarcinoma, and TMB as an immunotherapy biomarker in gastric cancer.

The authors also elaborate on the combination of targeted and immunotherapy for HER2-positive gastro-oesophageal adenocarcinoma.