Different Treatment Algorithms for Gastric Cancers May Improve Outcomes

An increasing understanding of gastric cancer as multiple disease states will continue to improve outcomes in the field, according to John L. Marshall, MD.

CancerNetwork® spoke with Marshall, physician executive director of the MedStar Washington DC Integrated Hematology-Oncology Division and the Otto J Ruesch Center for the Cure of GI Cancers, and chief medical officer of the Lombardi Comprehensive Cancer Center at Georgetown University, about developments in gastrointestinal (GI) cancers that have the potential to change clinical practice. He discussed possible advancements beyond the FDA approval of zolbetuximab-clzb (Vyloy) plus chemotherapy for patients with locally advanced unresectable or metastatic HER2-negative, Claudin 18.2–positive gastric or gastroesophageal junction (GEJ) adenocarcinoma.

Marshall began by stressing that the field is garnering a deeper understanding of gastric cancers as multiple disease states as opposed to a singular disease. Despite a need for an even greater understanding of managing GI cancers, he expressed that continuing development of treatment algorithms may improve outcomes for patients in diverse molecular GI cancer subgroups. He stated that increased knowledge pertaining to immunotherapy may help foster more favorable patient outcomes.

Marshall further emphasized a need to incorporate Claudin 18.2 testing in patients with gastric cancers. He concluded by recommending that Claudin 18.2 testing should supplement both microsatellite instability (MSI) testing and HER2 testing in light of developments in the field.

Transcript:

We are increasingly understanding that gastric cancer is more than 1 disease. It is molecularly broken out into different subgroups, and depending on the molecular subgroups, we have different treatment algorithms. We are beginning to gain knowledge that I believe, over time, is going to continue to improve outcomes. As with many of the GI cancers, we still have a long road [ahead] to understand how to better manage this cancer [type]. I am hopeful that with improvements in our understanding of immunotherapy approaches, [and with] more precision medicine targets and therapies, that we will see the kind of robust improvements that we need.

The biggest thing that we need to do as clinicians is begin to incorporate Claudin 18.2 testing for our patients. We are not learning fast enough––incorporating fast enough––the molecular testing that is required based on the speed of development. Make sure, if you have a [patient with] gastric cancer [for whom] you do HER2 testing and MSI [testing], you also now have to do Claudin 18.2 [testing].

Reference

Astellas’ VYLOY™ (zolbetuximab-clzb) approved by U.S. FDA for treatment of advanced gastric and GEJ cancer. News release. Astellas Pharmaceuticals. October 18, 2024. Accessed October 23, 2024. https://tinyurl.com/5745k9a8