The Intricacies of Sequencing Immunotherapy in GI Cancers

When sequencing immunotherapies with or without chemotherapy in gastrointestinal (GI) cancers, the wide range of disease types makes the process nuanced, according to Valerie Lee, MD.

Lee, an assistant professor of Oncology at Johns Hopkins University School of Medicine and a medical oncologist at Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, spoke with CancerNetwork® about the current landscape of immunotherapy in GI cancer.

For gastric cancers, she mentioned that PD-L1 combined positive score (CPS) and mismatch repair status factor into where immunotherapy might enter treatment. In patients with mismatch repair deficiency, for example, immunotherapy gets added to treatment in earlier settings.

Another example she gave was colorectal cancer, which is not typically treated with immunotherapy in earlier lines. Additionally, pancreatic cancer is a disease type for which oncologists and cancer care experts are still working to figure out the role of immunotherapy.

Transcript:

GI cancer encompasses such a large volume of diseases. When it comes to gastric cancers, taking a look at that molecular profiling and figuring out how high that PD-L1 CPS is [while] discussing as a team, and [looking for] mismatch repair deficiency, we might start adding immunotherapy in the earlier side [of treatment]. In contrast, for something like colorectal cancer, which doesn’t respond as well to immunotherapy, we’re not going to be adding that in the frontline [setting], except in the patients who have mismatch repair deficiency. The most recent data seem to show—what we historically wondered about—that we should try to [treat] people [more intensely]. We can get better depths of response with the immunotherapy for that small group of patients who can have an amazing response and live a long time. All of it depends on the type.

In pancreatic cancer, we’re still trying to figure this out. We’re thinking that, over time, [immunotherapy’s] role—while we are looking into it in the metastatic setting—a lot of the interest is also in saying how can we potentially prevent [that] and so a lot of those trials are looking [at that].