Dr Gibson Reviews Breakthroughs With HER2, Immunotherapy for Esophageal GC

Michael Gibson, MD, PhD, shares an overview of novel breakthroughs and progress with HER2 and immunotherapy targets to treat esophageal gastric cancer at the 2022 GDU GI Meeting.

Transcript

Hi, my name is Michael Gibson. I am affiliated with the Vanderbilt-Ingram Cancer Center and the Vanderbilt University Medical Center, where I am the Director of Translational Research for Head and Neck and Esophagogastric Oncology. I am here at the invitation of doctors Ilson and Eng, where I participated yesterday morning in the opening session which was, of course, esophagogastric cancer. My role was to present an overview of HER2-directed therapy and immunotherapy for esophagogastric cancer. This was a 30-minute discussion. Dr. Ilson presented the other therapies for esophagogastric cancer.

The overview I provided, the high points number one is that there have been many breakthroughs in therapy for this disease, for which historically we didn't have much. So, the last few years are really very heartening regarding progress in helping patients live longer, curing more patients, and then a quick example of a few of these. In the HER2-directed therapy space, I discussed KEYNOTE-811, which is an ongoing trial. The interim analysis, and this trial was from Dr Janjigian at Memorial, looked at patients with HER2 positive disease, which is about 20% of all patients. And those selected for this marker were treated with chemotherapy, platinum/5-Fu based plus trastuzumab plus, here's the kicker, pembrolizumab and the response rates were remarkably better in the group that got essentially the ToGA regimen plus pembrolizumab. And that was for patients that were treated with frontline recurrent metastatic disease.

The second major take home message, also involved immunotherapy. You can see a recurring theme here. And these were developments which gave us the opportunity to treat the other 80% of patients who did not over express the HER-2 biomarker. And for those patients who have recurrent or metastatic disease, first line previously untreated for advanced disease were randomized in two trials. One was CheckMate 649 and the second I believe was KEYNOTE-580 and essentially patients got chemotherapy plus or minus either pembro or nivo. And the survival was better when we added immunotherapy to chemo.

So as a result of all three of these trials, the FDA has approved the use of these approaches for this disease. Well, it's remarkable that we now have it least three, if not more, positive studies which are FDA approved for our patients, who I think were in great need. Still are, but you have to think glasses half full for esophagogastric cancer.