Takeaways From CheckMate-649 in Gastric/GEJ/Esophageal Cancers

Ryan Sugarman, MD, Strategic Partnerships medical director, Division of Solid Tumor Oncology at Memorial Sloan Kettering Cancer Center, discusses the key takeaways from the CheckMate-649 trial (NCT02872116) of patients with advanced gastric cancer, gastroesophageal junction (GEJ) cancer, and esophageal adenocarcinoma receiving nivolumab (Opdivo) combined with chemotherapy compared with chemotherapy alone in the first-line.

In the study, patients given nivolumab plus chemotherapy experienced superior responses in overall survival (OS), progression-free survival, and even maintained their health-related quality of life for a longer duration of time than those who received chemotherapy alone.

Sugarman notes that the findings of CheckMate-649 were the basis for the FDA’s approval of nivolumab in April 2021 as an initial form of treatment in this patient population. This FDA approval marks the earliest first-line immunotherapy in the gastric cancer space.

Transcription:

0:08 | The number 1 takeaway is the FDA approved this and it can be an important thing to consider when treating in the first-line because as I mentioned earlier, esophageal gastric cancer is sadly a deadly cancer that is one of the worldwide lead killers of cancer. The combination is just second to only lung cancer for worldwide killer cancers. When we think about our first-line therapy, we want to give the best we can because sadly, very few patients make it to a second-line therapy. Most patients don't because they had progression of disease and may not be able to tolerate further chemotherapy when they progress. For patients who have a CPS greater than or equal to 5, the benefit is very clear.

0:59 | We're also happy to report that for all comers, there seems to be a benefit. I would consider the combination of chemotherapy plus immunotherapy as a standard first-line consideration for any patient with advanced esophageal gastric cancer. I would be careful in those patients who have a history of autoimmune disease or other immunotherapy concerns. If the patient is older or more frail, I would be careful in these situations too, especially if the CPS was low. But for those greater than 5, I would try in most patients to start this therapy, and I would also give when less than 5 if it is a fit for a younger patient.