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Determining the Optimal Timing for Immunotherapy in Patients With GEJ Cancers

Daniel Catenacci, MD
Published Online:4:38 PM, Fri November 1, 2019

Daniel Catenacci, MD, associate professor, University of Chicago, discusses how he makes decisions with immunotherapeutic agents for the treatment of patients with gastroesophageal junction (GEJ) cancer. He says he bases his sequencing decisions on a number of factors.

These factors include what line of therapy the patient is at, patient characteristics, burden of disease, symptoms, and the patient’s performance status, says Catenacci. Many studies today are selecting patients based on given biomarkers that require central confirmation. However, it takes several weeks to get that answer, imposing a selection bias by making patients wait that period of time before beginning treatment.

Because of this, patients on studies are not necessarily representative of real-world patients where many patients need therapy almost immediately in any line, Catenacci adds. These patients are often better served by receiving chemotherapy first.

These factors can help in determining the sequence of immunotherapy for patients with GEJ cancer. Catenacci says treatment can be optimized for reacheach patient by understanding the patient characteristics and the biology of the tumor. For example, if the tumor is microsatellite instability-–high, this patient should receive immunotherapy as early as possible as the benefits can be large in this population. Catenacci concludes that we do not want to miss the opportunity to treat these patients because they tend to progress rapidly in the first- or second-line setting.
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