Despite advances in treatment options, most patients diagnosed with non-metastatic((cancer that has not yet spread to other organs) gastric or gastroesophageal junction (GEJ -the junction where the stomach connects to the oesophagus) cancer die of their disease. These patients typically receive a combination of radiation and chemotherapy before surgery, or chemotherapy before and after surgery, with poor prognosis.

The phase-2 PANDA trial sought to investigate the safety and effectiveness of the neoadjuvant combination of atezolizumab, an immunotherapy drug, and chemotherapy before surgery,

Atezolizumab works by allowing your immune system to recognize hidden cancer cells and attack them more effectively. Such neoadjuvant treatments are given before the main treatment, usually surgery, to shrink tumors, improve surgical outcomes, and reduce the recurrence of the disease.

In this small-scale study, 20 of the 21 patients enrolled received one round of atezolizumab by itself first, followed by four rounds of a combination of atezolizumab with chemotherapy (docetaxel, oxaliplatin, and capecitabine) before surgery. The results highlighted that 14 out of 20 patients responded positively to the treatment, with 9 patients experiencing complete tumor eradication. Four years post-treatment, 13 of the 14 patients who saw a reduction in their tumors continue to remain cancer-free. Unfortunately, 5 of the 6 non-responders experienced a recurrence and have passed away. Overall, most of the patients experienced mild side effects, and the treatment was well tolerated, with fatigue being the most common immune-related adverse event. This allowed the group of patients to complete all cycles of the neoadjuvant regimen.

Of note, after the first round of immunotherapy, some immune cells surrounding the tumors were more active, suggesting the treatment could be working well. This could predict whether treatment is effective at a very early stage, and will help select patients who will benefit the most from this treatment.

The promising response rate, in conjunction with the high survival of the responders following the treatment combination, justifies further validation and exploration through larger randomised controlled studies.

Access the publication HERE

Author:
Natasha Muench