Gastric cancer, also known as stomach cancer, is a type of cancer that begins in the lining of the stomach. It is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide. The incidence of gastric cancer varies by geographic region and population, with higher rates in Eastern Asia, South America, and Eastern Europe.
Locally advanced gastric cancer refers to cancer that has spread from the lining of the stomach to nearby structures, such as the lymph nodes, but has not yet spread to distant sites in the body (metastasized). The prognosis for locally advanced gastric cancer depends on the stage of the cancer, as well as other factors such as the patient’s age, overall health, and the presence of certain genetic mutations. In general, the prognosis is worse for patients with more advanced stages of cancer.
The standard of care for the management of locally advanced gastric cancer typically involves a combination of surgery, chemotherapy, and/or radiation therapy. The specific treatment plan will depend on the stage of the cancer, the location of the tumor, and the patient’s overall health. Surgery is typically the first-line treatment for locally advanced gastric cancer, and it may be given with perioperative chemotherapy and/or radiation therapy to help kill any remaining cancer cells and reduce the risk of the cancer returning. In some cases, neoadjuvant therapy (treatment given before surgery) may be recommended to shrink the tumor and make it easier to remove surgically.
A recent study, called NEONIPIGA, evaluated the use of neoadjuvant immunotherapy using the drugs nivolumab and ipilimumab in patients with locally advanced, resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma that is deficient in mismatch repair (dMMR) and has high microsatellite instability (MSI-H). The study found that neoadjuvant therapy with nivolumab and ipilimumab was feasible and had no unexpected toxicity, and it resulted in a high pathological complete response (pCR) rate in patients with dMMR/MSI-H resectable gastric/GEJ adenocarcinoma. A pCR is a measure of how well the treatment shrank the tumor. Of the 29 patients who underwent surgery, 58.6% (17 patients) had a pCR. At the time the study’s database was locked, no patients had experienced a relapse and one patient had died without experiencing a relapse.
This new data suggests that neoadjuvant immunotherapy with nivolumab and ipilimumab may be a viable treatment option for patients with locally advanced, resectable gastric or GEJ adenocarcinoma that have deficient mismatch repair. Further studies are needed to confirm these findings and determine the optimal use of this treatment in this patient population.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.
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