The Evolving Landscape of Neoadjuvant Immunotherapy in Gastroesophageal Cancer
1
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
2
Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA 15212, USA
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2024, 16(2), 286; https://doi.org/10.3390/cancers16020286
Submission received: 6 November 2023
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Revised: 3 January 2024
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Accepted: 5 January 2024
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Published: 9 January 2024
(This article belongs to the Special Issue Role of Immunotherapy in Gastroesophageal Cancers: Advances, Challenges and Future Strategies)
Simple Summary
Esophagogastric cancer remains a devastating diagnosis, even when it is caught early the likelihood of its recurrence remains significant. Treatment prior to surgery, or neoadjuvant therapy, has been a mainstay of management for esophagogastric cancers over the past decade. In this review we discuss how this treatment paradigm has evolved and the trials and pertinent results that shape our management today. Unlike traditional methods that focus solely on surgery, radiotherapy or chemotherapy, immunotherapy uses drugs that stimulate the body’s immune system to fight cancer. By administering these drugs before surgery, clinicians aim to shrink tumors, making them easier to remove, and potentially preventing cancer from spreading or returning in the future. We discuss recent studies investigating its use before surgery that have shown promising results indicating improved outcomes and reasonable safety. Although more research is needed to fully understand its long-term benefits, neoadjuvant immunotherapy represents a hopeful advancement in the quest for more effective treatments against this type of cancer.
Abstract
Despite advances in treatment strategies and surgical approaches in recent years, improving survival outcomes in esophagogastric cancer (EGC) patients treated with curative intent remains a significant area of unmet need. The recent emergence of adjuvant immunotherapy as the standard of care for resected EGC demonstrates the impact of immunotherapy in improving recurrence-free survival. Neoadjuvant and perioperative immunotherapies represent another promising approach with potential advantages over adjuvant therapy. Despite the promising results of early neoadjuvant immunotherapy studies, there are several challenges and future research needs. The optimal timing, duration and number of doses in relation to surgery and the optimal combination of immunotherapies are still unclear. In addition, rigorous correlative studies need to be performed to identify biomarkers for patient selection and treatment response prediction to maximize the benefits of neoadjuvant immunotherapy. In this review, we provide a concise summary of the current standard of care for resectable EGC and discuss the rationale for the use of immune checkpoint inhibitors in this setting and the pre-clinical and early clinical data of these novel therapies. Finally, we will examine the potential role and future direction of immunotherapy in the treatment paradigm and the perceived challenges and opportunities that lay ahead.
