University Medical Centre Maribor, Maribor, Slovenia.
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Curr Opin Oncol. 2021 Jul 1;33(4):362-367. doi: 10.1097/CCO.0000000000000728.
This article reviews recent randomised clinical trials on systemic treatment of oesophago-gastric cancers in the perioperative and metastatic setting.
Adding nivolumab to first-line chemotherapy improved survival in patients with metastatic gastric/gastro-oesophageal junction/oesophageal adenocarcinoma with PD-L1 combined positive score (CPS) ≥ five in a global trial and progression-free survival in metastatic gastric/gastro-oesophageal junction cancers in an Asian trial. The addition of pembrolizumab to first-line chemotherapy improved survival in metastatic oesophageal cancer patients, with the most benefit in oesophageal squamous cancer and tumours with high PD-L1 expression (CPS ≥ 10). Adjuvant nivolumab improved disease-free survival (DFS) in resectable oesophageal cancer patients with residual pathologic disease after neoadjuvant chemoradiation. In human epidermal growth factor receptor 2 (HER2)-positive oesophago-gastric adenocarcinoma, a phase II trial showed improved DFS when pertuzumab and trastuzumab were added to perioperative FLOT (5-fluorouracil/leucovorin, oxaliplatin, docetaxel). Another phase II trial showed improved response rates and survival in pretreated metastatic HER2-positive gastric and gastrooesophageal junction cancer patients who received the antibody-drug conjugate trastuzumab deruxtecan compared to physician's choice of chemotherapy.
Chemo-immunotherapy combinations will become the new standard of care for some patients with metastatic oesophago-gastric cancers. Adjuvant nivolumab is a new option for oesophageal cancer patients with poor response after neoadjuvant chemoradiation.
本文综述了近期关于围手术期和转移性食管胃腺癌系统治疗的随机临床试验。
在一项全球性试验中，纳武利尤单抗联合一线化疗可提高 PD-L1 联合阳性评分（CPS）≥5 的转移性胃/胃食管结合部/食管腺癌患者的总生存期，在一项亚洲试验中可提高转移性胃/胃食管结合部癌症患者的无进展生存期。帕博利珠单抗联合一线化疗可提高转移性食管癌患者的总生存期，在食管鳞癌和高 PD-L1 表达（CPS≥10）的肿瘤中获益最大。在新辅助放化疗后有残留病理疾病的可切除食管癌患者中，辅助纳武利尤单抗可改善无病生存期（DFS）。在人表皮生长因子受体 2（HER2）阳性的胃食管腺癌中，一项 II 期试验表明，在围手术期 FLOT（氟尿嘧啶/亚叶酸钙、奥沙利铂、多西他赛）中加入帕妥珠单抗和曲妥珠单抗可改善 DFS。另一项 II 期试验表明，与医生选择的化疗相比，在预处理的转移性 HER2 阳性胃和胃食管结合部癌患者中，抗体药物偶联物曲妥珠单抗 deruxtecan 可提高应答率和生存。
化疗免疫治疗联合将成为一些转移性食管胃腺癌患者的新标准。对于新辅助放化疗后反应不佳的食管癌患者，辅助纳武利尤单抗是一种新的选择。
