The first first-line immunotherapy for gastric cancer refreshes the survival period "The Lancet" publishes an important milestone

Gastric cancer is the fourth leading cause of cancer-related deaths worldwide and the third leading cause of cancer deaths in China

Until April this year, the treatment of advanced gastric cancer finally ushered in the first first-line immunotherapy

This approval is mainly based on evidence from the large randomized phase 3 clinical trial CheckMate-649

The "Lancet" concurrent review article also pointed out that CheckMate-649 is an important milestone in the treatment of advanced or metastatic gastric cancer, gastroesophageal junction cancer and esophageal adenocarcinoma

The paper published this time reports the results of Opdivo combined chemotherapy and chemotherapy alone in the CheckMate-649 study

The trial reached the primary endpoints of overall survival (OS) and progression-free survival (PFS) at the same time, and the data for different population segments are encouraging

Patients with high PD-L1 expression levels in tumor samples (comprehensive positive score [CPS] ≥ 5) benefit the most

Positive PD-L1 expression and CPS≥1 are also beneficial

Even without considering the expression of PD-L1, in all enrolled patients, the advantages brought by Opdivo combined with chemotherapy can still be seen! The Opdivo combined chemotherapy group significantly reduced the risk of death by 20% (median OS 13.

▲In CPS ≥ 5 (A), CPS ≥ 1 (B) and all patients, Opdivo combined with chemotherapy prolonged the overall survival (picture source: reference [1])

Further analysis showed that regardless of the state of microsatellite instability, Opdivo combined with chemotherapy has survival benefits; most of the population characteristics or disease characteristics did not affect the survival benefits of Opdivo combined with chemotherapy

Regardless of the expression level of PD-L1, Opdivo combined with chemotherapy also brought a higher remission rate

▲ Among patients with different PD-L1 expression levels, Opdivo combined with chemotherapy has a higher remission rate (data source: reference [1]; tabulation: new medical perspectives)

The study did not observe new safety signals

The paper pointed out that in the previously untreated patients with advanced gastric, gastroesophageal junction or esophageal adenocarcinoma, compared to chemotherapy alone, Opdivo is the first to show superior OS, PFS benefits and acceptable safety in combination with chemotherapy Sexual PD-1 inhibitor

It is worth noting that the main results of the CheckMate-649 Chinese subgroup have also been announced before, and Chinese patients have also benefited! The results of this treatment plan in Chinese patients are consistent with the results of the global population in the CheckMate-649 study

The research team also discussed the results of other immunotherapy trials for gastric cancer

The same review article mentioned that more and more evidence supports the role of checkpoint inhibitors in the treatment of upper gastrointestinal cancer

Note: The original text has been deleted

Reference

[1] Yelena Y Janjigian, et al.
, (2021).
First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial.
The Lancet, DOI: https://doi.
org/10.
1016/S0140-6736(21)00797-2