NCCN Updates Treatment Guidelines for Gastric Cancer

11/04/17

The National Comprehensive Cancer Network (NCCN) recently released updated guidelines for the management of multiple gastrointestinal cancers.

NCCN made similar changes to their guidelines for both gastric cancer and esophageal/esophagogastric junction cancer. Both additions involved changes to systemic therapy recommendations.

In gastric cancer, the change to systemic therapy for unresectable locally advanced, recurrent or metastatic disease (where local therapy in not indicated) involves pembrolizumab. The immuno-agent is now suggested for second-line or subsequent therapy for MSI-H or dMMR tumors. Additionally, the guideline includes, “Pembrolizumab for third-line or subsequent therapy for PD-L1 positive adenocarcinoma” as an added option.

In esophageal and esophagogastric junction cancers, the changes to systemic therapy for unresectable locally advanced, recurrent or metastatic disease (where local therapy is not indicated) are very similar to that of gastric cancer. In addition to pembrolizumab being indicated in second-line or subsequent therapy and as a third-line or subsequent therapy, the guideline reads, “The NCCN Panel recommends that the pembrolizumab treatment option be extended to patients with esophageal, in addition to esophagogastric junction, adenocarcinomas with PD-L1 expression levels ≥ 1.”

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In both disease guidelines, the regimen and dosing schedule in the “Principles of Systemic Therapy” sections were updated to reflect these changes.Zachary Bessette