Therapeutic Approach for Stage 4 Gastric Cancer - Episode 7
Manish A. Shah, MD:So, if a patient did receive second-line therapy, let’s say Taxol/Cyramza, and then after some time had progression, the question becomes, is third-line therapy an option? And I think that, again, there’s a discussion. It depends on the performance status. If a patient is having a lot of ascites, having visceral metastases, spending more time in bed than not in bed, then it’s not clear that a third-line treatment would be very beneficial, and it may be better to think about supportive care hospice. If, however, the patient is quite functional, active, and motivated to get third-line therapy, then obviously I would look for a clinical trial. But short of a trial, I would consider a third-line agent, typically irinotecan.
Closing thoughts for this case. We talked about how it’s unfortunately a typical presentation, and we talked a lot about the standard options for treatment. I might just mention that I think the options that we talked about in this interview are likely to change in the next 6 to 12 months. Drug development in gastric and GE junction cancer is quite active. Thousands of patients are in clinical trials. We’re awaiting the phase III data of the first-line regimen of FOLFOX plus or minus the MMP9 inhibitor andecaliximab. And if that study is positive, that may change options. We’re awaiting data from the first-line pembrolizumab study. The first-line nivolumab and ipilimumab phase III study is still accruing, but that may change options. And that’s just what we know about now. Just a month ago we received approval of our positive data of LONSURF in the third-line setting, so that will change options as well.
So, I think the shelf life for this interview is, fortunately, not going to be great, or actually you can invite me back, because there will be other options in the not-too-distant future.
Transcript edited for clarity.
A 54-Year-Old Man With Stage IV Gastroesophageal Junction Cancer