ecancermedicalscience

Research

The use of immune checkpoint inhibitors in advanced gastric/gastroesophageal adenocarcinomas – real-world evidence and the use of alternative dosing

20 Aug 2024
Aditya Dhanawat, Mehak Trikha, Manan Vora, Himanshu Gujarathi, Vikas Ostwal, Prabhat Bhargava, Rajiv Kaushal, Anant Ramaswamy

Background: Immune check point inhibitors (ICIs) have an established role in Microsatellite-Instability–High (MSI-H) and Combined Positive Score (CPS) high advanced gastric/gastroesophageal (G/GE) adenocarcinomas, but there is limited real world data with regard to practice patterns, and efficacy of standard doses (SD-ICIs) and alternative lower doses (LD-ICIs).

Methods: A retrospective study of patients with advanced G/GE adenocarcinomas receiving ICIs was conducted. The primary endpoint of the study was 12-month overall survival (OS), which was computed by Kaplan-Meier method.

Results: A total of 91 patients were available for analysis during the study period. Seventy-four patients (81%) received nivolumab, while the remaining received pembrolizumab. Fifteen patients (16%) had MSI-H status and had a 12-month OS of 60% and median OS of 15 months (median follow-up – 38.3 months). In the Microsatellite-Stable (MSS) cohort (84%; n = 76), ICIs (combined with chemotherapy) were used predominantly in pre-treated patients (54%; n = 41). Patients with CPS ≥5 (72%; n = 55) had improved survival compared to patients with CPS <5 (28%; n = 21) (12-month OS: 52% vs. 26%; Median OS: 12.8 months vs. 3.2 months; p = 0.005). There was no difference in survival between patients who received SD-ICIs (54%; n = 41) and LD-ICIs (46%; n = 35) (12-month OS: 42% vs. 48%; Median OS: 8.7 months vs. 11 months; p = 0.44).

Conclusions: Patients with advanced G/GEJ adenocarcinomas in the real world predominantly received ICIs during later lines of therapy as opposed to first line therapy. Using a CPS cutoff of ≥5 as opposed to CPS <5 predicts for improved survivals in MSS patients and patients receiving low dose ICIs have similar survival outcomes to patients receiving standard dose ICIs within the confines of a heterogenous study cohort.

Related Articles

Misbah Younus Soomro, Saqib Raza Khan, Hashim Ishfaq, Insia Ali, Mirza Rameez Samar, Arif Hameed, Nawazish Zehra, Munira Moosajee, Yasmin Abdul Rashid
Ghazal Tansir, Sameer Rastogi, Ekta Dhamija, Shamim Ahmed Shamim, Deepali Jain, Adarsh Barwad, Sunil Kumar, Rambha Pandey
Asma’u Usman, Shamsu Sahalu Bello, Aisha Abdurrahman, Fatima Abubakar Rasheed, Shuaibu Adam, Abubakar Dahiru
Yosra Abdelmonem Zamzam, Yomna Zamzam, Ayman Elsaka, Lamiaa Al Fadaly, Tamer Haydara, Alaa Ibraheem Amer
Leonardo G da Fonseca, Marina Acevedo Zarzar de Melo, Thamires Haick Martins da Silveira, Victor Junji Yamamoto, Pedro Henrique Shimiti Hashizume, Jorge Sabbaga