Monoclonal antibody therapy is available for the treatment of metastatic adenocarcinoma (cancer of mucous-secreting glands) of the stomach and gastroesophageal (GE) junction.
Topics Covered:
Approved immunotherapeutic agents
Combination therapy/treatment algorithms
Clinical trials
Approved immunotherapeutic agents (for gastric/gastroesophageal junction cancer)
The anti–HER-2 monoclonal antibody trastuzumab was approved in 2010 for the treatment of HER-2–positive metastatic adenocarcinoma of the stomach or GE junction for patients who have not been previously treated for metastatic disease.
In 2014, the anti–VEGFR-2 monoclonal antibody ramucirumab was approved for the treatment of adenocarcinoma of the stomach or GE junction that has progressed after treatment with certain chemotherapy regimens.
Gastric/gastroesophageal junction cancer combination therapy/treatment algorithms
The NCI recommends the addition of trastuzumab to first-line chemotherapy for patients with HER-2 over-expressing metastatic adenocarcinoma; this includes cisplatin and either 5-FU or capecitabine.
For second-line therapy, the NCI recommends ramucirumab with or without paclitaxel.
Current clinical trials for gastric/gastroesophageal junction cancer
- The anti–HER-2 monoclonal antibody pertuzumab is currently in phase 3 testing for the treatment of HER-2–positive gastric and GE junction adenocarcinoma in combination with trastuzumab.
- Trastuzumab emtansine is also under investigation in combination with a systemic chemotherapy regimen for metastatic or locally advanced gastric adenocarcinoma.
- The PD-1 checkpoint inhibitor pembrolizumab is in a phase 3 clinical trial for its use in combination with systemic chemotherapy as a first-line treatment of gastric and GE junction cancer.
- The investigational anti–PD-L1 monoclonal antibody avelumab (Pfizer) is in phase 3 trials for the treatment of metastatic or unresectable gastric and GE junction cancers.
- Immunotherapeutic agents in phases 1 and 2 include an HER-2 vaccine and several CAR therapies.
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