Transcript:Johanna C. Bendell, MD: Hello, and thank you for joining this OncLive Peer Exchange® titled, “Sequencing Decisions in Gastroesophageal Cancers.” Chemotherapy still plays a significant role in the treatment of advanced gastroesophageal cancers. However, recent progress has extended survival and is shifting the landscape toward less toxic regimens. In this OncLive Peer Exchange®, I’m joined by a group of international experts in gastroesophageal cancers who will shed light on the current understanding of molecular subtypes in gastroesophageal cancers and explain how the availability of newer treatment options is prompting discussions on sequencing.

I am Dr. Johanna Bendell, and I am the director of the GI Oncology Research Program and associate director of the Drug Development Unit at Sarah Cannon Research Institute in Nashville, Tennessee. Joining me for this discussion are: Dr. Ian Chau, consultant medical oncologist of the Gastrointestinal and Lymphoma Units at Royal Marsden Hospital and honorary senior lecturer at The Institute of Cancer Research in London and Surrey, United Kingdom. Welcome, and thank you so much for being here.

Ian Chau, MD: Thank you for having me.

Johanna C. Bendell, MD: Dr. Yelena Janjigian, assistant attending physician in the Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center in New York, New York.

Yelena Y. Janjigian, MD: Great to see you again.

Johanna C. Bendell, MD: It’s so good to have you again. Dr. Manish Shah, Bartlett Family Associate Professor of Gastrointestinal Oncology, chief of the Solid Tumor Service at Weill Cornell Medicine, New York-Presbyterian Hospital in New York, New York. It’s so good to have you here.

Manish A. Shah, MD: Nice to see you again.

Johanna C. Bendell, MD: And Dr. Kohei Shitara who joins us from the Department of Gastrointestinal Oncology of National Cancer Center Hospital East, Japan.

Kohei Shitara, MD: Thank you for the kind introduction.

Johanna C. Bendell, MD: Thank you so much. Thank you all for joining this discussion, and let’s begin. Let’s set the stage here for talking a little bit. We have a global panel, so let’s talk about the global nature of gastroesophageal cancers. We know that depending on what part of the world that you’re in, your gastroesophageal cancer may have a different prognosis, behavior, and response to therapy. And taking advantage of the folks that we have here, I’m going to start with Dr. Shitara. Because being from the West, we’re used to treating our western type of cancers. But can you tell us about the difference in gastroesophageal cancers in Japan?

Kohei Shitara, MD: Okay. Gastric cancer is still a very common disease in Japan. The incidence is slightly decreasing, maybe because of the eradication of helicobacter pylori for benign disease, but it is still very high. And there are approximately 70% of patients diagnosed with early disease because we have a good screening system. But at the same time, approximately 30% of patients were diagnosed with advanced disease and the primary result is the cancer cell deaths. We still have 50,000 new gastric cancers, at best, annually, so this is a still very big issue in Japan.

Johanna C. Bendell, MD: Yes, the high prevalence of these gastric cancers in Japan led to your screening programs, which is incredible that you catch disease early. But even despite being able to catch disease early, it sounds like there’s still a lot of potential help we could give for patients in Japan in terms of extending their survival. Manish, tell me a little bit about the western gastric cancer.

Manish A. Shah, MD: Worldwide, gastric cancer is a significant problem. H. pylori is the key cause of gastric cancer. It actually infects half the world’s population and is the major cause for gastric cancer across the world. In the United States, in Europe, and in much of South America as well, we’re seeing a rise in the proximal stomach cancers, GE junction cancers. We’re having some emerging molecular analyses of these tumors that suggest that they are, in fact, distinct from other subtypes of gastric cancers. So, epidemiologically, it’s still a significant problem. It is declining in the United States and Europe. H. pylori is still the main cause of the disease.

Johanna C. Bendell, MD: And when we look at survival rates for patients with gastric cancer in the East as opposed to the West, we keep hearing that patients who are diagnosed with gastric cancer in the East tend to have a better survival. And the question is, is that because of treatment patterns? Is that because of diagnosis times? is that because of pathology? Dr. Chau, what do you think?

Ian Chau, MD: I think it’s always very difficult to disentangle all of these factors, and all of these factors probably do play a big part. As Dr. Shitara already said, there is a screening program happening in Japan. Whereas because the incidence of gastric cancer is relatively uncommon in the West, in Europe, and in the United States, the screening program is not really a cost-effective program to implement on a country level. So, we are seeing more advanced disease, as Manish said. Certainly, within the UK, localized stage that is suitable for radical treatment only comes to about 35% of gastric cancer. I think, therefore, most patients are found at a local advanced or metastatic state, and, likewise, their survival is going to be poorer. But whereas stage by stage, if they are both diagnosed at the same stage, I also think, certainly, patients are diagnosed at an older age group as well in the West. And I think the ability for them to tolerate more intensive treatment, more lines of treatment, is going to be less than younger patients who have less comorbidities.

Transcript Edited for Clarity