Bassel El-Rayes, MD:I would like to conclude by discussing the future directions and unmet needs in gastric cancer. Of course, there are a number of unmet needs in this disease. The therapy that we have has impacted survival of our patients, but unfortunately, the majority of patients with stage IV disease eventually progress and become refractory to all available therapies.
Therefore, we need more effective systemic therapies. One area of active research in the disease includes the role of immune therapy. Recently we’ve seen data suggesting immune therapy used with chemotherapy combinations may be beneficial in the frontline setting, specifically with nivolumab. Whether this approach will open the door for other immunomodulatory approaches in the frontline or second-line setting is still an area of active research.
In addition, it is important as we approach gastric cancer that we realize that it is not 1 disease but many diseases. Therefore, we must incorporate in our management plan a clear approach to select patients based on their molecular profile and recognize that we now have 3 biomarkers—MSI [microsatellite instability], HER2/neu, and the CPS [combined positive score], which is based on PD-L1expression. This biomarker profile keeps expanding and allows us to better select patients for therapies they would benefit from in the frontline, second-line, and third-line settings.
Transcript edited for clarity.
Case: A 66-Year Old Male With HER2+ Gastric Cancer