Immunotherapy comparable to chemo for some advanced stomach cancers

An immunotherapy drug could prove just as effective as chemotherapy in prolonging the lives of patients with advanced cancers of the stomach or food pipe.

For some, the immune-boosting treatment offered improved survival compared to standard treatment.

The immunotherapy, called pembrolizumab (Keytruda), was most effective for patients whose cancers carry high levels of a molecule called PD-L1, according to the results of a new study that will be presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.  But this was only seen when the immunotherapy drug was used alone. When combined with chemotherapy, it added no extra survival benefits to patients.

Finding the best responses

Immunotherapy drugs like pembrolizumab work by boosting patients’ immune systems to recognise and attack cancer cells.

The clinical trial included people living with advanced cancer located in the stomach or at the border between the stomach and the food pipe (esophagus), also known as gastro-esophageal junction cancer.

Of the 763 patients on the trial, 7 in 10 had stomach cancer and 3 in 10 had cancer at the border of the esophagus and stomach – in all cases, the tumours didn’t carry a molecule called HER2.

Patients were randomly split into 3 groups and were given either:

  • chemotherapy;
  • pembrolizumab; or
  • chemotherapy and pembrolizumab combined.

Results show pembrolizumab was as effective as chemotherapy in prolonging survival in patients with advanced cancer. And for those whose cancer cells carry high levels of an important molecule called PD-L1, 4 in 10 patients (39%) taking pembrolizumab were alive 2 years after treatment, compared to just 2 in 10 (22%) of those treated with chemotherapy.

Adding pembrolizumab to chemotherapy appears to provide little benefit, while adding significant extra cost, but giving pembrolizumab alone to patients with tumours that have high levels of PD-L1 does improve survival


Front-Line Pembrolizumab Is Promising Alternative to Chemotherapy for Advanced Gastroesophageal Junction and Gastric Cancers. ASCO 2019.

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