Dr. Hwang on Considerations for Second-Line Treatment in Gastric/GEJ Cancer

Jimmy Hwang, MD, medical oncologist, Levine Cancer Institute, Atrium Health, discusses considerations for second-line treatment in gastric/gastroesophageal junction (GEJ) cancer.

Treatment selection in the second-line setting for patients with gastric/GEJ cancer depends largely on what was given in the first-line setting, says Hwang. It is unknown whether checkpoint inhibitors can be continued into the second-line setting in gastric/GEJ cancer if they were administered up front, such as with trastuzumab (Herceptin) in HER2-positive breast cancer or bevacizumab (Avastin) in colorectal cancer, Hwang explains.

Treatment selection is difficult in the second-line setting for this patient population because it is a largely data-free landscape. Hwang says. However, on January 15, 2021, the FDA approval fam-trastuzumab deruxtecan-nxki (Enhertu) for the treatment of adult patients with locally advanced or metastatic HER2-positive gastric/GEJ adenocarcinoma who have received a previous trastuzumab-based regimen. Patients with HER2-positive disease who receive pembrolizumab (Keytruda), chemotherapy, and trastuzumab in the frontline setting are eligible for trastuzumab deruxtecan in the second-line setting, but there are no data to inform how patients who received up-front pembrolizumab will fare with the antibody-drug conjugate, concludes Hwang.