Clinical significance of combined therapy with immune checkpoint inhibitor in perioperative treatment for locally advanced gastric cancer or adenocarcinoma of gastroesophageal junction
10.3760/cma.j.cn441530-20240507-00166
- VernacularTitle:围手术期联合免疫检查点抑制剂治疗局部进展期胃癌或胃食管结合部腺癌的临床意义
- Author:
Zhenggang ZHU
1
Author Information
1. 上海交通大学医学院附属瑞金医院外科 上海消化外科研究所 上海市胃肿瘤重点实验室，上海 200025
- Keywords:
Stomach neoplasms, locally advanced;
Adenocarcinoma of gastroesophageal junction;
Perioperative therapy;
Immune checkpoint inhibitor;
Pathological complet
- From:
Chinese Journal of Gastrointestinal Surgery
2024;27(7):659-665
- CountryChina
- Language:Chinese
-
Abstract:
The clinical application of immune checkpoint inhibitor (ICI) offers novel treatment modality for locally advanced gastric cancer (LAGC) and adenocarcinoma of the gastroesophageal junction (AGEJ), with the crucial benefit of providing higher cure rates. These agents have become part of standard treatments in the perioperative setting for selected cases, such as tumor with MSI-H/dMMR, high expression of CPS (≥5) or EBV (+), MSI-H and MSS/TP53+ according to tumor immunohistochemical, genetic testing or molecular characterization. An in-depth understanding of the immune response mechanisms in "cold" and "hot" tumors enables us to better identify ICI beneficiary and further provide a rationale for converting nonresponsive "cold" tumors into responsive "hot" tumors, subsequently allowing nonresponders to benefit from ICI immunotherapy. Several recent clinical trials clearly demonstrated a synergistic and complementary effect of combining ICI with chemotherapy or chemoradiotherapy, as well as combining ICI with anti-HER2 or anti-VEGF/VEGFR and chemotherapy. Compared with chemotherapy alone, the combination treatment can significantly improve pCR, MRR or ypT0N0, and is expected to improve the prognosis. This article reviews the results of a series of clinical trials in recent years in the field of perioperative application of ICI with other modalities in LAGC/AGEJ, aiming at expanding upon the discussion of current standard neoadjuvant and adjuvant therapies for LAGC/AGEJ and exploring the feasibility of new perioperative combined immunotherapy in the future.
