Nivolumab/Chemo Yields Long-Term Survival in Advanced Gastric Cancers

Cancer research · Gastric cancer

First‑line nivolumab plus chemotherapy provides a durable survival benefit in advanced gastric cancers, particularly in patients with a PD‑L1 CPS of 5 or higher.

The CheckMate 649 phase III trial demonstrates that first‑line nivolumab combined with chemotherapy yields a significant and long‑term improvement in overall survival (OS) and progression‑free survival (PFS) for patients with untreated advanced gastric, gastro‑esophageal junction, and esophageal adenocarcinoma. The benefit is most pronounced in patients whose tumors express a PD‑L1 combined positive score (CPS) of ≥ 5, with a 29 % reduction in risk of death and a 5‑year OS rate of 16 % versus 6 % with chemotherapy alone. The combination remains effective in MSI‑high tumors and overall, across multiple subgroups, with durable response rates and median duration of response of 8.5 months. Grade 3/4 treatment‑related adverse events occurred in 60 % of combination‑treated patients, highlighting the need for vigilant toxicity monitoring.

These results provide robust evidence that adding the PD‑1 inhibitor nivolumab to first‑line chemotherapy offers a durable survival advantage for advanced gastric cancer patients, particularly those with high PD‑L1 expression. The 5‑year follow‑up confirms long‑term efficacy and supports adoption of this regimen as a new standard of care.

Evidence level: Irányelv / elfogadott gyakorlat. Magas szintű klinikai elfogadottság.

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