Efficacy and safety of taxane plus ramucirumab for advanced gastric cancer after chemotherapy plus nivolumab

Rákkutatás · Gastric cancer

Sugemalimab added to standard CAPOX chemotherapy significantly improves overall survival and progression‑free survival in treatment‑naïve patients with unresectable locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma with PD‑L1 CPS ≥ 5.

Homologous recombination deficiency (HRD) is associated with increased tumor immunogenicity, but its clinical relevance in metastatic gastric cancer (mGC) treated with immunotherapy-containing regimens is unclear. We investigated 139 mGC patients receiving nivolumab plus chemotherapy as first‑line therapy between May 2022 and May 2024; tissue‑based next‑generation sequencing (NGS) was performed in 116 patients and ctDNA‑based NGS in 24. HRD was defined by pathogenic or likely pathogenic variants in HRR genes. HRD‑positive tumors (14.7%) were associated with longer progression‑free survival (median 23.1 vs. 9.6 months; p=0.032) and overall survival (median not reached vs. 17.9 months; p=0.027); HRD positivity remained an independent favorable prognostic factor for OS (HR 0.247; p=0.028). HRD‑positive tumors had higher high‑TMB and MSI‑high frequencies. Exploratory ctDNA‑based HRD analysis in the small subset did not show a significant association with survival outcomes. Tissue‑based HRD positivity may provide complementary prognostic information for mGC patients treated with nivolumab plus chemotherapy as first‑line therapy.

Bizonyítékszint: Irányelv / elfogadott gyakorlat. Magas szintű klinikai elfogadottság.

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