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BRONCHOGENIC CARCINOMA

The FDA approved sotorasib (AMG 510) for the treatment of KRAS G12C mutated lung cancers after progression on first-line treatment.

Atezolizumab (PD-L1 inhibitor) can be given for 1 year post–adjuvant chemotherapy for resected stage II to IIIA NSCLC, based on a phase 3 trial showing improvement in disease-free survival compared with adjuvant chemotherapy without atezolizumab. For stage III NSCLCs, a phase 3 trial has shown improved survival outcomes by adding durvalumab (PD-L1 inhibitor) as consolidation therapy post–definitive chemoradiation.

Five-year follow-up data for patients with 50% or greater PD-L1 expression show that patients who received pembrolizumab versus chemotherapy alone had improved median overall survival of 26 months versus 13 months.

Skoulidis F et al. N Engl J Med. [PMID: 34096690]

Reck M et al. J Clin Oncol. [PMID: 33872070]

Felip E et al. Lancet. [PMID: 34555333]

ESOPHAGEAL CANCER

For patients who complete neoadjuvant chemoradiation and undergo a complete resection but are found to have residual cancer in the resection specimen, a year of adjuvant immunotherapy with nivolumab is recommended.

Ahmed O et al. Clin Gastroenterol Hepatol. [PMID: 33813072]

GASTRIC ADENOCARCINOMA

Triplet chemotherapy for resectable gastric cancer is recommended for patients who are fit but is associated with more toxicity than doublet chemotherapy.

The development of immunotherapy represents a promising strategy in a selected patients with locally advanced and metastatic gastric cancer. Testing for microsatellite instability-high (MSI-H), mismatch repair deficiency (dMMR), PD-1, and PD-L1 is recommended in advanced disease to identify tumors that may respond to immunotherapy.

ASGE Standards of Practice Committee; Jue TL et al. Gastrointest Endosc. [PMID: 33168194]

de Steur WO et al; CRITICS investigators. Ann Oncol. [PMID: 33227408]

Kawazoe A et al. Jpn J Clin Oncol. [PMID: 33241322]

Ng SP et al. Ann Surg Oncol. [PMID: 33689079]

MALIGNANCIES OF THE SMALL INTESTINE

For advanced/unresectable disease, first-line doublet chemotherapy is standard. Two trials suggest value from adding bevacizumab to chemotherapy. Pembrolizumab is an accepted treatment modality for mismatch repair-deficient tumors.

COLORECTAL CANCER (CRC)

For the 50% of patients with metastatic CRC who have KRAS/NRAS/BRAF wild-type tumors, cetuximab and panitumumab (monoclonal antibodies to the epithelial growth factor receptor, in combination with chemotherapy, can extend median survival by 2 to 4 months compared with chemotherapy alone. For the 5% to 10% with BRAF V600E sequence variations, targeted combination therapy with BRAF and EGFR inhibitors extend overall survival to 9.3 months, compared with 5.9 months for those receiving standard chemotherapy.

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