Immunotherapy-Based Neoadjuvant Treatment of Advanced Microsatellite Instability–High Gastric Cancer: A Case Series

Authors:
Louisa Liu Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, California; and
Department of Medical Oncology and Therapeutics Research,

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Yanghee Woo Division of Surgical Oncology, Department of Surgery, and

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Massimo D’Apuzzo Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California.

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 MD, PhD
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Laleh Melstrom Department of Medical Oncology and Therapeutics Research,

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Mustafa Raoof Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California.

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Yu Liang Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California.

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Michelle Afkhami Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California.

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Stanley R. Hamilton Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California.

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Joseph Chao Department of Medical Oncology and Therapeutics Research,

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Volume/Issue:
Volume 20: Issue 8
Online Publication Date:
Aug 2022
DOI:
https://doi.org/10.6004/jnccn.2022.7023
Restricted access

Despite the use of first-line therapies like fluoropyrimidine and platinum-based cytotoxic chemotherapy, gastric cancer (GC) continues to carry a poor prognosis. Recent subgroup analyses of first-line phase III trials have demonstrated that patients with microsatellite instability–high (MSI-H) metastatic GC derive significant improvement in survival rates when immune checkpoint inhibitors (ICIs) are combined with chemotherapy compared with chemotherapy alone. However, it remains to be seen whether the success of ICIs in the metastatic setting can be translated into earlier stages of GC with resectable disease. We report 6 cases of locally advanced, nonmetastatic MSI-H GC that all demonstrated favorable response following treatment with pembrolizumab in addition to neoadjuvant chemotherapy. With the exception of immune-related colitis in one patient, pembrolizumab was well-tolerated. To our knowledge, this is the first reported US case series of patients treated with an ICI in combination with neoadjuvant chemotherapy for advanced, nonmetastatic, resectable or unresectable MSI-H GC.

Submitted January 22, 2022; final revision received April 3, 2022; accepted for publication April 29, 2022.

Disclosures: Dr. Hamilton has disclosed serving on an advisory board for Merck & Co., Inc. Dr. Chao has disclosed receiving personal fees from Amgen Inc., Astellas Pharma Inc., AstraZeneca plc, Bristol-Myers Squibb Company, Coherus Biosciences, Daiichi-Sankyo Company, Ltd., Eli Lilly and Company, Foundation Medicine, Inc., Geneos Therapeutics, MacroGenics, Inc., Merck & Co., Inc., Novartis International AG, Ono Pharmaceuticals Co, Ltd, Roche Holding AG, Silverback Therapeutics, and Turning Point Therapeutics; and receiving grant/research support from Brooklyn Immunotherapeutics, Inc. and Merck & Co., Inc. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was partially supported by the Stand Up To Gastric Cancer Interception Award (Y. Woo, J. Chao).

Correspondence: Joseph Chao, MD, Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010. Email: jchao@coh.org
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
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Copyright:
Copyright © 2022 by the National Comprehensive Cancer Network 2022
Page Numbers:
9
Article Category:
Research Article
Received:
22 Jan 2022
Accepted:
29 Apr 2022
Print Publication Date:
01 Aug 2022
Online Publication Date:
Aug 2022

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