In The Know: Analyst answers — Today’s gastric cancer therapies

What advancements have been made in gastric cancer treatment over the last 12 months? We sat down with Duncan Emerton, senior director of Syndicated Insights at FirstWord, to dive into recent research. After conducting in-depth interviews with key opinion leaders (KOLs), here he provides a sneak peek into the findings of what changes have come to the treatment landscape and what experts envision for the near future.

FirstWord: What was the main objective for this research?

Duncan Emerton: The goal was to understand key trends in the evolution of treatment of patients with gastric cancer. This was segmented into several sub-objectives, including, but not limited to: key issues and unmet needs in the management of gastric cancer; the optimal use of chemotherapy; strategies, tactics and changes with currently approved treatments; views, insights and expectations for immuno-oncology; and future treatment dynamics.

FW: Based on the research, what is the general sentiment from KOLs on the progression of gastric cancer treatment landscape?

DE: Overall there is a sense of optimism, but experts are keen to emphasise that the size of the challenge in gastric cancer must not be underestimated. The research came up with six key conclusions:

  1. There is a gap in the market for patients with unresectable cancers.

  2. Drugs that deliver improved response rates and longer overall survival are needed.

  3. Biomarkers will be crucial to patient segmentation and future drug development strategies.

  4. Chemotherapy will remain an essential aspect of the treatment paradigm, but its limited duration of response will see it being combined with other agents.

  5. KOLs are hopeful that checkpoint inhibitors will move into the first-line treatment space in combination with chemotherapy.

  6. In terms of changes in the treatment landscape over the next five years, KOLs are most enthusiastic about immunotherapy (IO).

FW: What were some of the most insightful interview quotes? What did they teach us?

DE: Despite the excitement for IO-based regimens, KOLs believe that the market will become crowded, and that this may limit market share for early-stage candidates. Avelumab (Bavencio; Merck KGaA/Pfizer), durvalumab (Imfinzi; AstraZeneca) and atezolizumab (Tecentriq; Roche) may find it difficult to enter the market, as the treatment landscape is already targeted on multiple fronts by their competitors, including Keytruda (pembrolizumab; Merck & Co.) and Opdivo (nivolumab; Bristol-Myers Squibb/Ono Pharmaceutical). Focusing on clinical differentiation will be key in driving market share, and this could be done by assessing novel combinations.

“If Keytruda plus chemotherapy shows benefit in the first line, there is not even going be a role for avelumab because people will be already using Keytruda and just keeping people on the Keytruda. I don’t see why they would even switch to avelumab.” --US KOL

“[Durvalumab is] like a biosimilar, a ‘me too’ drug, relative to Keytruda and Opdivo. The likelihood of benefit and potential issues of responses are going to be very similar to what we have seen already.” --US KOL

“I think that atezolizumab is probably the same as durvalumab. They are pretty much interchangeable in their efficacy. So maybe as a maintenance therapy after first-line treatment, maybe as a novel combination.” --EU KOL

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