Current Role of Immunotherapy in Gastric, Esophageal and Gastro-Esophageal Junction Cancers—A Report from the Western Canadian Gastrointestinal Cancer Consensus Conference

Round 1

Reviewer 1 Report

Just two comments: 1. A clarity on what CPS measure should be standard, 1%, 5%, or 10% , is required. 2. A recommendation for adjuvant immunotherapy where CPS < 1%, or not measured, in light of the Checkmate 577 data to date? It is a good document, well written, and have no concerns whatsoever.

Author Response

1. A clarity on what CPS measure should be standard, 1%, 5%, or 10%, is required.

Response: Thanks very much for the comments. In the revised manuscript we have specified cut off value for the positive result and elaborated it further with a new reference (29) in the last paragraph of page 7. 

 

2. A recommendation for adjuvant immunotherapy where CPS < 1%, or not measured, in light of the Checkmate 577 data to date? It is a good document, well written, and have no concerns whatsoever.

Response: Thanks very much for this comment. We have specified that 1 year of adjuvant nivolumab is recommended in patients with localized esophageal or GEJ cancer with residual disease following preoperative chemoradiation therapy regardless of PD-L1 status.

Reviewer 2 Report

The Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC)  aims to develop consensus opinion of health care professionals from across four Western  Canadian provinces, attempting  to define best care practices and to improve care and outcomes for patients with gastro-intestinal cancers. It can be used as a guide for the treatment of gastric, esophageal and gas-2 tro esophageal junction cancers, but it is not very suitable for publication as an article.

Author Response

The Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC)  aims to develop consensus opinion of health care professionals from across four Western  Canadian provinces, attempting  to define best care practices and to improve care and outcomes for patients with gastro-intestinal cancers. It can be used as a guide for the treatment of gastric, esophageal and gas-2 tro esophageal junction cancers, but it is not very suitable for publication as an article.

Response: The WCGCCC is an interactive multidisciplinary conference attended by health care professionals from across four Western Canadian provinces British Columbia, Alberta, Saskatchewan, and Manitoba who are involved in the care of patients with gastrointestinal cancer. The WCGCCC consensus statements addressing various key areas in gastrointestinal cancer have previously been published in Current Oncology with a goal to define best care practices and to improve care and outcomes for patients with gastrointestinal cancers. We believe that this paper will provide a guidance to health care professionals who are involved in the management of patients with gastric, esophageal and gastroesophageal cancer.  We have revised the format and have included introduction, method, result and conclusions. 

Reviewer 3 Report

Conference (WCGCCC) for a guideline of immunotherapy in gastroesophageal cancer for health care professionals from across four Western Canadian provinces British Columbia, Alberta, Saskatchewan, and Manitoba, to improve care and outcomes of treatments. Below are some comments made on the manuscript itself, I hope they would help authors during revision.

 

1. From the beginning, the guide should give an updated section of data on gastrointestinal cancer and its treatment status in western Canada, which will emphasize the significance and importance of improving immunotherapy. This will benefit a wider audience.

 

2. The numbers of subtitles and secondary subtitles are misleading. Taking Lines 53 and 54 as an example, as there are no 2.2 in this section, the secondary subtitles should be used in Lines 59 and 63. The same issues are found in other sections. Unless it is the format of the journal, I suggest authors to standardize the numbering in the most appropriate way.

 

3. Are there any discussions on the options when resistance occur?

Author Response

1. From the beginning, the guide should give an updated section of data on gastrointestinal cancer and its treatment status in western Canada, which will emphasize the significance and importance of improving immunotherapy. This will benefit a wider audience.

Response: Thanks very much for the comment. We have added an introduction highlighting the current standard treatment for early and advanced stage gastroesophageal cancer.

 

2. The numbers of subtitles and secondary subtitles are misleading. Taking Lines 53 and 54 as an example, as there are no 2.2 in this section, the secondary subtitles should be used in Lines 59 and 63. The same issues are found in other sections. Unless it is the format of the journal, I suggest authors to standardize the numbering in the most appropriate way.

Response: We have numbered each section and sub-section for clarification. In the revised paper we have added sections on introduction, methods, result or summary of evidence and conclusions. The summery of evidence is the largest section that has several subsections and are numbered accordingly.

 

3.Are there any discussions on the options when resistance occur?

Response: We have a section in the “summary of evidence” or result section that highlighted immunotherapy in previously treated patients “5.3.2  Immunotherapy for previously treated patients or later-line therapy”. In the “conclusion” section we have added an statement that re-challenging with immunotherapy is not recommended for patients who progressed on immunotherapy.

In addition, we have thoroughly reviewed the paper and corrected grammatical or typo errors (track changes). We sincerely thank the reviewers for their helpful comments. We hope that the changes we have made meet the expectations of the reviewers and that this work is now suitable for publication in Current Oncology.

Round 2

Reviewer 2 Report

No other comments