Is PDL1 Assessment a Prime Time Predictor for Esophageal Cancer Management?

Short Communication

Programmed Death-Ligand 1 (PD-L1) expression has been emerged as one of the key predictive marker of response to immunotherapy [1]. However, the timing of usage of Checkpoint Inhibitors (CPI) is not in global consensus. In United States, CPI is approved in third line setting, while in Japan it is approved upon progression from initial chemotherapy with no regard to biomarker expression [2]. The recent trial [3] comparing pembrolizumab with chemotherapy (paclitaxel monotherapy) for PDL1 CPS scores >1 did not significantly prolong overall survival (median 9.1 versus 8.3 months, HR 0.82, 95% CI 0.66-1.03), and the Objective Response Rate (ORR) was similar (16 versus 14 percent). However, the adverse event profile was favorable with pembrolizumab. Therefore, the combination of Ramucirumab and paclitaxel remains the preferred strategy for most patients with advanced oesophageal cancers who have progressed on first line fluoropyramidine or platinum based regimen [4].

References

1. Muro K, Chung HC, Shankaran V, Geva R, Catenacci D, Gupta S, et al. Pembrolizumab for patients with PD-L1-positive advanced gastric cancer (KEYNOTE-012): a multicentre, open-label, phase 1b trial. Lancet Oncol. 2016; 17: 717-726.
2. Kang YK, Boku N, Satoh T, Ryu MH, Chao Y, Kato K, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebocontrolled, phase 3 trial. Lancet. 2017; 390: 2461-2471.
3. Shitara K, Özgüroglu M, Bang YJ, Di Bartolomeo M, Mandalà M, Ryu MH, et al. Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061): a randomized, open-label, controlled, phase 3 trial. Lancet. 2018; 392: 123-133.
4. Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014; 15: 1224-1235.