Gastric cancer with low PD-L1 expression may not benefit from immunotherapy!

*For medical professionals to read for reference only, Professor Peng Zhi will take you to understand the latest research of JCO! Recently, the internationally renowned oncology journal JCO published an online article entitled "Data analysis results of subgroups of gastric or esophageal adenocarcinoma with low expression of programmed cell death ligand 1 (PD-L1) with immunosuppressive therapy (Low Programmed Death-Ligand 1).
–Expressing Subgroup Outcomes of First-Line Immune Checkpoint Inhibitors in Gastric or Esophageal Adenocarcinoma)”, the Medical Tumor Channel specially invited Professor Peng Zhi from the Department of Gastrointestinal Oncology, Peking University Cancer Hospital, to interpret and discuss the clinical significance of the data results of this study
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It may be necessary for clinicians to view the positive results of immunotherapy research dialectically.
Q: Does this research have any guiding significance for the clinical practice of gastric cancer immunotherapy in my country? ▎Professor Peng Zhi: The incidence of upper gastrointestinal tumors in China is relatively high.
About half of the new cases of gastric cancer and esophageal cancer in the world each year are Chinese patients
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In terms of pathological classification, there is no significant difference between gastric cancer patients in China and Europe and the United States, but esophageal cancer patients in Europe and America are mainly adenocarcinoma, while in China, squamous cell carcinoma is the majority, and more than 90% of esophageal cancer patients have squamous cell carcinoma.
cancer
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Asia is one of the places with high incidence of gastric cancer.
However, compared with Japan and South Korea, the concept of "early diagnosis and early treatment" for gastric cancer in China is far from being popularized.
Most of the newly diagnosed gastric cancer patients are in the middle and late stages.
There are great expectations for breakthroughs in the field of diagnosis and treatment
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The emergence of immunotherapy has brought new hope to many cancer patients, including gastric cancer.
However, which gastric cancer patients can benefit from immunotherapy has always been a controversial topic
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The publication of the results of this study will provide reference data for regulatory agencies in China when approving drug indications, and help relevant workers make more prudent decisions
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In addition, this study further suggests which patients may not benefit from immunotherapy, so it can indirectly help clinicians to further screen patients who are more suitable for immunotherapy
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This retrospective study calculated data results that were not reported in several studies by reconstructing KM curves, which directly suggested that gastric cancer patients with low PD-L1 expression could not obtain significant survival benefit from immunotherapy, which reminded every tumor Physicians and the staff of drug regulatory authorities carefully and dialectically view the positive results in clinical studies
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At the same time, this retrospective study also gives certain warnings to clinicians when designing prospective studies or clinical practice
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Predicting the efficacy of gastric cancer immunotherapy only from the expression level of PD-L1 may be "biased" Q medical community: What are the novelties and deficiencies of this study in your opinion? ▎Professor Peng Zhi: It is worth noting that we should view the results of this study dialectically
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First, the PD-L1 CPS score that the study focused on is only one of the reference indicators to evaluate the efficacy of immunotherapy in patients
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In fact, not every patient with PD-L1 CPS >5 or >10 can benefit from immunotherapy, and most patients with microsatellite high instability (MSI-H) can also benefit from immunotherapy
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Therefore, from the current clinical cognition of gastric cancer, it is not comprehensive to predict the prognosis of patients from the PD-L1 expression level alone
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In addition, the clinical detection of PD-L1 expression levels in patients still needs to be further popularized, and there is also a lack of clear guidelines or consensus evidence for the interpretation standards of test data
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There is still a long way to go in clinical practice to guide clinical practice through the detection of PD-L1 expression levels.

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Second, the researchers only came to the conclusion that "patients with low PD-L1 expression cannot obtain significant survival benefit from immunotherapy" only through data calculation, rather than the clear results obtained through clinical research.
Clinical studies are needed to verify
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Gastric adenocarcinoma is a highly heterogeneous disease, and the location of onset and other individual factors of patients may cause great differences in the condition.
More and more emphasis is placed on "individualization", and clinicians have different degrees of differences in the diagnosis and treatment process of different patients
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Therefore, the relevant clinical research should carry out a more diverse stratified design in the trial design, and classify gastric cancer patients as much as possible, so as to find a more "individualized" and more effective treatment strategy
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