VESTIGE: Adjuvant Immunotherapy in Patients With Resected Esophageal, Gastroesophageal Junction and Gastric Cancer Following Preoperative Chemotherapy With High Risk for Recurrence (N+ and/or R1): An Open Label Randomized Controlled Phase-2-Study

Background: Perioperative chemotherapy plus surgery is one recommended standard treatment for patients with resectable gastric and esophageal cancer. Even with a multimodality treatment more than half of patients will relapse following surgical resection. Patients who have a poor response to neoadjuvant chemotherapy and have an incomplete (R1) resection or have metastatic lymph nodes in the resection specimen (N+) are especially at risk of recurrence. Current clinical practice is to continue with the same chemotherapy in the adjuvant setting as before surgery. In the phase II randomized EORTC VESTIGE trial (NCT03443856), patients with high risk resected gastric or esophageal adenocarcinoma will be randomized to either adjuvant chemotherapy (as before surgery) or to immunotherapy with nivolumab and low dose ipilimumab (nivolumab 3 mg/kg IV Q2W plus Ipilimumab 1 mg/kg IV Q6W for 1 year). The primary endpoint of the study is disease free survival, with secondary endpoints of overall survival, safety and toxicity, and quality of life. This is an open label randomized controlled multi-center phase-2 superiority trial. Patients will be randomized in a 1:1 ratio to study arms. The trial will recruit 240 patients; recruitment commenced July 2019 and is anticipated to take 30 months. Detailed inclusion/exclusion criteria, toxicity management guidelines, and statistical plans for EORTC VESTIGE are described in the manuscript.Clinical Trial Registration: The trial is registered with www...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research

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n Domenico Raulli Riccardo Rosati Uberto Fumagalli Romario Giovanni De Manzoni Jari Räsänen Sandro Mattioli Stage significantly affects survival of esophageal and esophago-gastric junction adenocarcinomas (EA/EGJAs), however, limited evidence for the prognostic role of histologic subtypes is available. The aim of the study was to describe a morphologic approach to EA/EGJAs and assess its discriminating prognostic power. Histologic slides from 299 neoadjuvant treatment-naïve EA/EGJAs, resected in five European Centers, were retrospectively reviewed. Morphologic features were re-assessed and corr...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
This article reviews recent advances in the use of immune checkpoint inhibitor therapy in esophagogastric cancers.PMID:34637430
Source: Clinical Advances in Hematology and Oncology - Category: Cancer & Oncology Authors: Source Type: research
ConclusionsTogether, we show a sex-specific prognostic effect of TANs in gastric cancer within a Caucasian cohort. For the first time, we showed that this sex-specific prognostic effect of TANs can also be seen in esophageal cancer.
Source: Gastric Cancer - Category: Gastroenterology Source Type: research
This study aims to investigate tumor heterogeneity impact on IHC staining when evaluating PD-L1 expression using PD-L1 IHC 22C3 pharmDx. The effect of tumor heterogeneity was evaluated based on the PD-L1 diagnostic status of PD-L1 IHC 22C3 pharmDx stained tumor tissue sections at relevant diagnostic cutoffs for non–small cell lung carcinoma, gastric or gastroesophageal junction adenocarcinoma, urothelial carcinoma, head and neck squamous cell carcinoma, esophageal cancer and triple negative breast cancer. Overall agreement for the PD-L1 diagnostic status was assessed for each tumor type within a given specimen block ...
Source: Applied Immunohistochemistry and Molecular Morphology - Category: Chemistry Tags: Research Articles Source Type: research
ConclusionEndoscopic mucosal resection after Nissen's Fundoplication is a safe modality, with high rate of success in complete eradication of BE in symptomatic GERD patients, especially those with severe anatomical impairment in distal esophageal segment. As a concurrent procedure, endoscopic procedures may be beneficial in the terms of reducing the early recurrence rates, which seems to be important issue during the management of BE. By doing synchronous endoscopic procedures and fundoplication, one might observe a true anatomy of esophagogastric junction in its entirety and might be able to truly observe the distal exten...
Source: QJM - Category: Internal Medicine Source Type: research
J BUON. 2021 Jul-Aug;26(4):1523-1530.ABSTRACTPURPOSE: To evaluate early outcome and long term survival in a mixed stage population of patients undergoing upfront esophagectomy for esophageal cancer.METHODS: Retrospective analysis of the data of 92 patients who underwent esophagectomy (thoracoabdominal: 76, Ivor-lewis: 16) between 1998 and 2017. Tumors were located in gastro-esophageal junction (52), lower third (31) and middle third (9) of the esophagus. Histology was: 73 adenocarcinomas and 19 squamous cell carcinomas. The stomach was used for reconstruction in 90 patients. A neck anastomosis was performed in 7 patients. ...
Source: Journal of B.U.ON. - Category: Cancer & Oncology Authors: Source Type: research
This article reviews recent randomised clinical trials on systemic treatment of oesophago-gastric cancers in the perioperative and metastatic setting. Recent findings Adding nivolumab to first-line chemotherapy improved survival in patients with metastatic gastric/gastro-oesophageal junction/oesophageal adenocarcinoma with PD-L1 combined positive score (CPS) ≥ five in a global trial and progression-free survival in metastatic gastric/gastro-oesophageal junction cancers in an Asian trial. The addition of pembrolizumab to first-line chemotherapy improved survival in metastatic oesophageal cancer patients, with the ...
Source: Current Opinion in Oncology - Category: Cancer & Oncology Tags: GASTROINTESTINAL TRACT: Edited by Alain Hendlisz and Francesco Sclafani Source Type: research
SummaryDuring this year ’s virtual congress of the European Society of Oncology (ESMO) some practice-changing abstracts were presented. Especially immunotherapy (IO) has found its way into the treatment of esophageal (EC) and gastric cancer (GC) in both the adjuvant and palliative setting. The CheckMate 577 trial, which was presented in EMSO Presidential Symposium III, showed a doubling in disease-free survival (DFS) for patients with resected esophageal (EC) or esophagogastric junction cancer (EGJC) following neoadjuvant chemoradiation therapy (CRT), who had not achieved a pathological complete respon...
Source: Memo - Magazine of European Medical Oncology - Category: Cancer & Oncology Source Type: research
This study aimed to investigate whether combining anti-PD-L1 Atezolizumab with BEV may have a synergistic effect and enhance the efficacy of both treatments in cisplatin resistant epithelial ovarian cancer (CREOC). We retrospectively analyzed 124 epithelial ovarian cancer (EOC) patients from Gynecologic Oncology Department of Tianjin Cancer Hospital between January 2013 and June 2018, who all were diagnosed with cisplatin resistance due to progressing
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
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