Update ESMO: gastric and esophageal cancer

During this year’s virtual congress of the European Society of Oncology (ESMO) some practice-changing abstracts were presented. Especially immunotherapy (IO) has found its way into the treatment of esophageal (EC) and gastric cancer (GC) in both the adjuvant and palliative setting. The CheckMate 577 trial, which was presented in EMSO Presidential Symposium III, showed a doubling in disease-free survival (DFS) for patients with resected esophageal (EC) or esophagogastric junction cancer (EGJC) following neoadjuvant chemoradiation therapy (CRT), who had not achieved a pathological complete response, treated with nivolumab versus placebo. For advanced disease, the KEYNOTE-590 trial revealed a benefit of adding pembrolizumab to chemotherapy for patients with locally advanced or metastatic adenocarcinoma (EAC) or squamous cell carcinoma of the esophagus (ESCC) or EGJC Siewert type 1. In the CheckMate 649 study, patients (predominantly Caucasians) with advanced gastric, EGJC or EAC benefitted from the addition of nivolumab to chemotherapy in terms of overall survival (OS) and progression-free survival (PFS). In contrast, in the ATTRACTION‑4 trial, the Asian population gained a prolongation of PFS but not of OS by adding IO to chemotherapy.