A medical oncologist reviews the available frontline treatment options for patients with gastric adenocarcinoma.
Case: A 60-Year-Old Man with Stage IV Gastric Adenocarcinoma
Clinical Presentation:
Initial Clinical Workup and Diagnosis:
Current Treatments:
This is a video synopsis/summary of a Case-Based Peer Perspectives series featuring David Zhen, MD.
In the first-line treatment of metastatic gastric adenocarcinoma, cytotoxic chemotherapy remains the standard of care, typically consisting of a fluoropyrimidine (either 5-fluorouracil [5-FU] or capecitabine) and a platinum agent (oxaliplatin or cisplatin). While there are variations in chemotherapy regimens, all combinations are considered equivalent. In the US, FOLFOX (leucovorin, fluorouracil, and oxaliplatin) is more commonly used due to its favorable toxicity profile compared to capecitabine and cisplatin.
Recent advancements have led to the addition of PD-1 checkpoint inhibitors in the frontline setting. The CheckMate649 trial demonstrated improved overall survival (OS) with the addition of nivolumab to FOLFOX or CAPOX (capecitabine and oxaliplatin) in patients with a combined positive score of 5% or greater. The median OS was 14.4 months in the nivolumab plus chemotherapy arm vs 11.1 months in the chemotherapy alone arm. Similarly, the KEYNOTE-859 trial showed a benefit in OS with the addition of pembrolizumab to 5-FU, cisplatin, or CAPOX, with a slightly greater benefit in patients with a PD-L1 score greater than or equal to 10.
Zhen prefers using nivolumab with FOLFOX due to the alignment of his institution’s dosing schedules (every 2 weeks) but acknowledges that using pembrolizumab is also appropriate.
Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.
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