Finding Ways to Improve Outcomes in dMMR Gastroesophageal Cancer

The use of neoadjuvant therapy followed by surgery is a current standard of care for patients with DNA mismatch repair deficient gastroesophageal cancer, according to Adrienne Bruce Shannon, MD.

Shannon, a complex general surgical oncology fellow from Moffitt Cancer Center, spoke about PET standard uptake value (SUV) imaging in the space. She presented findings on the use of neoadjuvant immunotherapy in this population and their pathologic responses at the Society of Surgical Oncology (SSO) 2024 Annual Meeting.

She also touched on creating markers to identify patients who may be susceptible to gastroesophageal cancer in the future and to better determine if preventative surgery will be needed. She highlighted that gene profiling may also be useful to better stratify patients and determine treatment for this smaller population.

Transcript:

From our standpoint, the PET SUV reduction is very interesting. From there, we would like, as an expansion of the project, to look at things like radiomics scores related to imaging, and whether that can predict if somebody does have a response [to treatment]. The nature of how we practice at Moffitt is that we still, even if we give neoadjuvant immunotherapy, offer surgery as a standard of care following that neoadjuvant treatment. That being said, there is a very hefty discussion to be had with the patient that there’s a 60% chance that there, frankly, could be no cancer there, and they may not “need” an operation. There’s also a 40% chance that if we didn’t do surgery, they could still have cancer sitting there.

Ultimately, these patients still agree to go through with surgery. But there’s a discussion there. If we were able to create a profile to be able to risk stratify these patients—are they more likely to be in that 60%, or are they more likely to be in that 40%?—that’s where these early findings of the PET SUV reduction may come into play. We’re hoping to expand on that and try to look at some of the scoring that can be done based on just imaging alone. The next step beyond that would be to incorporate gene profiling on these patients to see if there is something that we can use as almost a biomarker to also help stratify them. The PET SUV reduction is very interesting in that regard because it’s going to create the next steps for some of the projects we hope to do in the future on this very limited group of patients.

Reference

Shannon AB, Mehta RJ, Mok SR, et al. Pathologic response to neoadjuvant immunotherapy in DNA mismatch repair protein-deficient gastroesophageal cancers. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-24, 2024; Atlanta, GA. Abstract 94.