Experts say that combining an immune checkpoint inhibitor with chemotherapy is the standard first-line treatment for patients with HER2-negative metastatic gastric or gastroesophageal junction (GEJ) cancer. Because many patients receive only one line of therapy, choosing the best initial treatment based on biomarkers is important.
In a case discussion, a 60-year-old man with stage IV gastric cancer and lung metastases was treated with nivolumab (Opdivo) plus FOLFOX after testing showed HER2-negative disease, PD-L1 CPS of 5, and other biomarker results.
Experts reviewed three major clinical trials of nivolumab, pembrolizumab, and tislelizumab, finding that all three combinations improved survival compared with chemotherapy alone and produced similar overall results.
The panel also highlighted challenges with biomarker testing, including delays, inconsistent PD-L1 scoring, and the need for manual test ordering. Since the treatments have similar effectiveness, doctors often choose a regimen based on insurance coverage, hospital policies, experience, and dosing convenience.