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KEYNOTE-062 Highlights Role of Pembrolizumab in Gastric/GEJ Cancer Subtypes

David H. Ilson, MD, PhD
Published Online: 8:58 PM, Fri October 11, 2019

David H. Ilson, MD, PhD, an attending physician and professor of medicine at Memorial Sloan Kettering Cancer Center, discusses the current role of pembrolizumab (Keytruda) in patients with gastric cancer or gastroesophageal junction (GEJ) adenocarcinoma based on the results of the KEYNOTE-062 trial.

Although PD-L1 is thought to be somewhat of a predictive biomarker in patients with microsatellite stable disease, the response rates were higher in this subset of patients with a combined positive score of 10 or higher, says Ilson. The response rates were even slightly higher in those patients who received pembrolizumab and chemotherapy, but there was no improvement in survival compared with chemotherapy alone.

The problem with upfront pembrolizumab is that a vast majority of the patients will progress and cross over to chemotherapy early on. However, Ilson argues that this is not a fair comparison because virtually all patients that receive pembrolizumab initially will also get chemotherapy within a few months.

Currently, pembrolizumab is not ready to be moved to the frontline for the treatment of patients with gastric or GEJ cancer. However, Ilson adds that microsatellite instability–high (MSI-H) patients are the exception to this. Now the question has become whether patients with MSI-H should start with a checkpoint inhibitor or receive it in the second-line setting.

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