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New data found in late December 2021 supports the claim that immunotherapy can be used as a frontline treatment for GI cancers

Dr. Syma Iqbal, in a piece for Oncology Nursing News, recently detailed how the use of immunotherapy is beginning to show progress in the treatment of gastrointestinal malignancies, including upper GI cancer and hepatocellular carcinoma (HCC).

Iqbal discussed the advancement as part of the OncLive© Institutional Perspectives in Cancer webinar, of which she is an event co-chair.

“The biggest [advance] in GI oncology has been the addition of immunotherapy,” Iqbal said. “We have had VEGF inhibitor therapy in some format across tumors in GI oncology, including gastric and colon cancers, as well as HCC with the TKIs. Now, by incorporating immunotherapy we have made advances across these disease types in GI oncology.”

The use of checkpoint inhibitors and target therapy had also shown negative results over the past several years, but with this new breakthrough, doctors worked to better incorporate these inhibitors in a frontline setting with HER2-negative and HER2-postive disease. Iqbal called it “the biggest change we’ve had this year [in 2021].”

She added, “Also, in the adjuvant setting, checkpoint inhibitors have been approved for patients with GEJ and esophageal adenocarcinoma, having shown a doubling in disease-free survival. That was a huge step forward for upper GI tumors.”

Iqbal explained that protocols that previously did not involve immunotherapy are already in the process of being amended. In her opinion, those that choose not offer immunotherapy will suffer, as the process has quickly become popular with patients now that trials and studies are beginning to show positive results.

“We are already seeing that because patients are coming in and asking for immunotherapy,” Iqbal said. “Patients are aware of it; they see commercials on television. Now that there is data to support it, it is a hard discussion with patients to offer them something that doesn’t include [immunotherapy].”

Protocols aren’t the only pieces being updated to include the new treatment. Iqbal believes that immunotherapy guidelines and approvals will change soon as data is reviewed further. Currently, immunotherapy approval is open to all-comers, while guidelines from The National Comprehensive Cancer Network recommend immunotherapy only in select cases. These guidelines were published prior to FDA approval.

“When the guidelines for [nivolumab (Opdivo)] in HER2-negative patients were proposed, they were based on CheckMate649 [NCT02872116], where the primary end point was a combined positive score [CPS] of 5 or greater,” she explained. “The guidelines reflected that and are recommended for patients who have a CPS of 5 or greater. The FDA gave a broad approval [to nivolumab plus chemotherapy] for all-comers as it appeared that all-comers benefitted. However, if we look at the subgroups, the benefit in the CPS less than 5 population is quite small, if at all.”

As data is further reviewed and compiled, guidelines and protocols will continue to evolve, while current studies, which did not factor in this advancement will be forced to be redesigned in a way to further discover new and more effective treatment options.