Page 59 - Helicobacter pylori and Gastric Cancer: From Tumor microenvironment to Immunotherapy

Abstract.
Objectives: Checkpoint inhibitor therapy is revolutionizing the management of the oncological disease. Despite gastric cancer being a common malignancy with a relatively poor prognosis, checkpoint inhibitor therapy has attracted relatively little attention for the treatment of this disease. We decided to perform a systematic review focusing on the potential usefulness of checkpoint inhibitors in patients with gastric cancer by reviewing all clinical trials involving checkpoint inhibitors in gastric cancer up to the 9th of September 2017.
Methods: We systematically review all randomized controlled trials on the 9th September 2017. We searched the. embase.com, Medline Ovid, Cochrane CENTRAL, Web of Science, Google Scholar, and databases of current ongoing randomized trials. A description assessment of randomized clinical trials (RCTs) was performed on Immune checkpoint inhibitors for PD1, CTLA-4 and PD-L1 (Atezolizumab, Avelumab, Durvalumab, Ipilimumab, Nivolumab, Pembrolizumab, and Tremelimumab) in gastric cancer patients.
Results: The current body of biomedical literature describes 3621 gastric cancer patients being treated with checkpoint inhibitors and compared to patients receiving chemotherapy. The PD-1 inhibitors pembrolizumab and nivolumab in conjunction appear to substantially outperform conventional chemotherapy, with more extended overall survival median (OS; 10.0 vs. 6.0 mo), a more significant objective response rate of 36% versus. 13%, p=0.10, with a reduced adverse event rate (33 % vs. 22%), although other checkpoint inhibitors appear somewhat less effective.
Translational impact: It seems that checkpoint inhibitor therapy in general, and PD-1-directed therapy, in particular, constitutes a rational therapeutic avenue for advanced gastric cancer.
MeSH keywords: Immunomodulator therapy; Gastric cancer; Biologic therapy; Biomarker
Immunotherapy Checkpoint Inhibition
Immuno checkpoint inhibition
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