Weijing Sun, MD, FACP, professor of medicine, The Sprint Professorship of Medicine Oncology, University of Kansas School of Medicine, director, Division of Medical Oncology, associate director, University of Kansas Cancer Center, discusses the design of the KEYNOTE-062 trial in advanced gastric/gastroesophageal junction (GEJ) cancer.

The randomized, phase 3 KEYNOTE-062 trial was a complex study that evaluated whether checkpoint inhibitors could be used in the frontline setting, as a single agent or in combination with chemotherapy, in patients with advanced gastric cancer, says Sun. Moreover, the analysis had a hierarchical design and consisted of 3 treatment arms. Patients were randomized 1:1:1 to receive pembrolizumab (Keytruda), pembrolizumab plus chemotherapy, or chemotherapy plus placebo. The primary end points of the trial were overall survival and progression-free survival in patients with PD-L1 combined positive score of 1 or greater, which was considered a noninferiority evaluation.

in September 2020, showed that among 763 enrolled patients with untreated, locally advanced/unresectable or metastatic gastric/GEJ cancer, pembrolizumab was noninferior to chemotherapy in terms of OS. Fewer adverse effects were also observed with the investigational regimen, Sun concludes.

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Weijing Sun, MD, FACP, discusses the design of the KEYNOTE-062 trial in advanced gastric/gastroesophageal junction cancer. 

Dr. Sun on the KEYNOTE-062 Design in Advanced Gastric/GEJ Cancer 

Weijing Sun, MD, FACP, professor of medicine, The Sprint Professorship of Medicine Oncology, University of Kansas School of Medicine, director, Division of Medical Oncology, associate director, University of Kansas Cancer Center, discusses the ​use of ramucirumab (Cyramza) plus paclitaxel in metastatic gastric cancer.

Findings from the randomized, multicenter, double-blind, placebo-controlled phase 3 RAINBOW trial ​demonstrated significantly improved overall survival with ramucirumab plus paclitaxel compared with placebo/paclitaxel in patients with advanced gastric orgastroesophageal junction adenocarcinoma, says Sun. 

​As such, the combination is now considered a standard of care that is generally well tolerated, ​Sun explains.

 Moreover, patients from North and South America, Europe, Asia, and Australia were included in the trial population. Patients appeared to benefit, irrespective of location, suggesting this regimen has utility across a diverse patient population, Sun concludes.

Weijing Sun, MD, FACP, discusses the ​use of ramucirumab plus paclitaxel in metastatic gastric cancer.

Dr. Sun on the Use of Ramucirumab/Paclitaxel in Metastatic Gastric Cancer

Weijing Sun, MD, FACP, professor of medicine, The Sprint Professorship of Medicine Oncology, University of Kansas School of Medicine, director, Division of Medical Oncology, associate director, University of Kansas Cancer Center, discusses remaining challenges in the first-line treatment of patients with gastric cancer.

The field of gastric cancer has witnessed several advances with regard to treatment. Such advances include the introduction of checkpoint inhibitors over recent years, Sun says. 

Although multiple options are available in the second- and third-line settings, 5-fluorouracil plus platinum-based chemotherapy remains the frontline standard of care for patients with gastric cancer, explains Sun.

Predictive biomarkers like HER2 can aid in guiding treatment selection, says Sun. However, the majority of biomarkers, such as microsatellite instability status and PD-L1 expression, are not gastric-cancer specific.

Future research efforts are ongoing to try to answer why checkpoint inhibitors, are advantageous in later-line settings, but appear to have little utility in the frontline space, Sun concludes. 

Weijing Sun, MD, FACP, discusses remaining challenges in the first-line treatment of patients with gastric cancer.










Dr. Sun on First-Line Treatment Challenges in Gastric Cancer  

Weijing Sun, MD, gastrointestinal oncologist at the University of Kansas School of Medicine, discusses the debate between the use of radiation and chemotherapy in patients with locally advanced gastroesophageal junction (GEJ) adenocarcinoma.

There are 2 preoperative therapeutic approaches for patients with locally advanced GEJ cancer, explains Sun—one includes radiation therapy and one does not. In the FLOT study, investigators explored a regimen comprised of fluorouracil, leucovorin, oxaliplatin, and docetaxel without radiation. In the CROSS study, investigators looked at the combination of carboplatin and paclitaxel with radiation. Although both are suitable options for patients, explains Sun, their respective roles are controversial.

Radiation is a local treatment as opposed to chemotherapy, which is a systemic therapy. They are both effective ways to shrink a tumor prior to resection, says Sun, but in terms of managing micrometastatic disease, radiation is not considered to be as effective as chemotherapy, as it is a local treatment. There are 2 parameters by which treatment effectiveness is assessed, says Sun. One is response rate, while the other is disease-free survival after surgery. In terms of response rate, both modalities demonstrate similar efficacy, but in terms of disease-free survival, the roles of radiation and chemotherapy are less clear, explains Sun.

Weijing Sun, MD

Articles

Dr. Sun on the KEYNOTE-062 Design in Advanced Gastric/GEJ Cancer

Dr. Sun on the Use of Ramucirumab/Paclitaxel in Metastatic Gastric Cancer

Dr. Sun on First-Line Treatment Challenges in Gastric Cancer

Dr. Sun Discusses the Debate Between Radiation and Chemotherapy in GEJ Cancers