Role of Immunotherapy in Advanced Gastroesophageal Cancer
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GASTROINTESTINAL CANCERS (J MEYER, SECTION EDITOR)
Role of Immunotherapy in Advanced Gastroesophageal Cancer Gretel Terrero 1 & A. Craig Lockhart 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Immunotherapy and tumor microenvironment have been at the forefront of cancer research over the past several decades. Here, we will review the role of immunotherapy in advanced gastroesophageal cancers including targeted antibodies, immunomodulating agents, vaccines, oncolytic virus therapy, and adoptive immunotherapy, and discuss the future direction for immunotherapy in this population. Recent Findings Targeted antibodies are already standard-of-care. An anti-PD-1 monoclonal antibody is currently FDA approved for second-line treatment of locally advanced or metastatic ESCC, as well as beyond second-line treatment of advanced G/GEJ cancers, and recent data suggests it may be considered in first-line treatment of advanced G/GEJ cancers. Combination therapies such as immunotherapy plus chemotherapy and/or radiotherapy, vaccines, oncolytic viral therapy, and adoptive immunotherapy in varying combinations are currently under active investigation. Summary Several trials are ongoing and are hoped to reach more efficacious and individualized treatment options in advanced gastroesophageal cancer, where novel treatment options are desperately needed. Keywords Immunotherapy . Advanced gastric cancer . Advanced esophageal cancer . Advanced gastroesophageal cancer . PD-1 . PD-L1
Introduction Survival for patients with advanced gastroesophageal cancer is poor, and is responsible for more than a million deaths per year globally [1]. In 2019, gastric cancer represented 1.6% of all cancer cases in the USA (with an estimated 27,510 new cases expected in 2019), with a 5-year relative survival rate of 5.3% for patients with distant disease [2]. Approximately 50% of patients with gastric cancer will be diagnosed with advanced-stage disease, although in some countries such as Japan and South Korea, where screening is routinely performed, early detection is more frequent [3]. The median overall survival (OS) duration of patients with metastatic gastric This article is part of the Topical Collection on Gastrointestinal Cancers * Gretel Terrero [email protected] A. Craig Lockhart [email protected] 1
Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 650L, Miami, FL 33136, USA
cancer ranges from 3 months with only supportive care treatment to 16 months in fit patients in clinical trials; thus, there is still an unmet need in oncology to improve the treatment options for these patients [4]. There is considerable overlap between gastric cancer and distal esophageal cancers in their treatment and clinical trial inclusion. In the USA, esophageal cancer represented 1% of all cancer cases with an estimated 17,650 new cases expected in 2019, with a 5-year relative survival rate of 4.8% for patien
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