Journal Article

Application of Value Framework to Phase III Trials of Immune Checkpoint Inhibitors in Esophageal and Gastric Cancer

Agrawal, Neha, Taflin, Nicholas F, Thawani, Rajat, Kardosh, Adel, Chen, Emerson Y

2023

Overview

Abstract Background Recent trials testing immune-checkpoint inhibitors in esophago-gastric malignancies have shown mixed results. We aim to assess key subgroups using the ASCO Net Health Benefit Score (NHBS) and ESMO Magnitude of Clinical Benefit Scale (MCBS). Materials and Methods A search for phase III trials of FDA-approved anti-PD-1 or anti-PD-L1 drugs in esophago-gastric cancer trials was identified using www.clinicaltrials.gov. These published studies were scored using the ASCO NHBS and ESMO MCBS. The ASCO NHBS scores were compared by primary site of cancer (esophageal vs gastric) and PD-L1 expression using the Mann-Whitney test and the ESMO-MCBS grading, by Fisher’s Exact test. Results Fifteen of 45 clinical trials were included. Of them, 6 were primarily esophageal cancer trials, and 9 were primarily gastric cancer trials. Ten stratified their analysis based on PD-L1 expression. The ASCO NHBS score was higher (mean 40, range 20 to 56.6 vs. mean 12, range −1.1 to 18.4, P < .01) for esophageal cancer than gastric cancer. No difference was observed in survival and response endpoints between the 2 groups. Similarly, the ESMO MCBS scored higher for esophageal cancer group than gastric cancer (P < .05). Additionally, the scores were higher in those with high PD-L1 expression vs. low PD-L1 (mean 36, range 11.2-66.6 vs. mean 14, range −19.5 to 43.6, P < .05). Conclusion The ASCO NHB and ESMO scores were consistently higher among esophageal cancer trials than gastric cancer trials and in those with high PD-L1 expression than low expression. Histology and PD-L1 expression should be considered when discussing value of immunotherapy to patients. Although survival has improved over the past several decades, esophageal and gastric cancers still have poor survival outcomes. This article reviews the risks and benefits of immunotherapy in different subgroups for treatment of esophageal and gastric cancers.

• Publisher: Oxford University Press
• Subject: Cancer / Care and treatment / Clinical trials / Clinical Trials, Phase III as Topic / Comparative analysis / Diagnosis / Drug therapy / Esophageal cancer / Esophageal Neoplasms - drug therapy / Esophageal Neoplasms - genetics / Gastric cancer / Humans / Immune Checkpoint Inhibitors - therapeutic use / Immunotherapy / Ipilimumab / Monoclonal antibodies / Oncology, Experimental / Stomach cancer / Stomach Neoplasms - drug therapy