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This article is from the NEJM Journal Watch
Strong Pathologic Complete Response to Immunotherapy in MSI-High Esophagogastric Cancer patients with high MSI esophageal gastric cancer who receive immunotherapy to achieve a high rate of
pathological complete remission Reviewed by David H.
Ilson, MD, PhD
This landmark study shows that neoadjuvant therapy with ipimumab and navurizumab achieves high rates
of complete pathological response.
Immune checkpoint inhibitors have significant anticancer activity against various MSI-H (microsatellite unstable) cancers
.
It has recently been confirmed that these agents are more effective than chemotherapy
in the first-line treatment of MSI-H metastatic colorectal cancer.
Recent studies have also shown that patients with locally advanced colon and rectal cancer receive a high
rate of clinical and pathological complete remission with anti-PD-1 therapy.
French researchers reported the results of the GERCOR NEONIPIGA study, a single-group Phase 2 trial
evaluating locally advanced MSI-H esophageal gastric adenocarcinoma.
Patients received a total of 12 weeks of ipimuzumab (given every 6 weeks) and navurizumab (every 2 weeks) for a total of 12 weeks before surgery, followed by surgery followed by weekly adjuvant navulimumab for
9 months.
Of the 32 patients included in the trial, 72% were male, median age 65 years, the same number of patients with the primary lesion located in the gastric and gastroesophageal junction, 62% had cT3N+, and 22% had Lynch syndrome
.
Of the 29 patients undergoing surgery, the primary endpoint (pathological complete remission rate ≥20%) (17 patients; 58.
6%), and another 14% of patients had residual tumor cells ≤ 10%.
Of the 3 patients who did not undergo surgery, 2 patients who refused surgery but achieved a clinical complete response based on the record, and a third patient who also achieved a clinical complete remission was found to have metastatic M1 lymph node lesions at the time of the initial staging review
.
The R0 resection rate for surgical patients is 100%.
One patient died postoperatively, while the remaining 31 patients did not relapse
.
No new safety signals
appear.
Commenting on NEONIPIGA is a landmark study that shows that patients with MSI-H esophageal gastric adenocarcinoma achieve high pathological complete remission rates
after receiving neoadjuvant therapy with ipimumab and navurizumab.
Given the potential effect of preoperative chemotherapy on locally advanced MSI-H esophageal gastric cancer, neoadjuvant therapy with immune checkpoint inhibitors should be further investigated in this patient population, and non-surgical treatment
of patients with clinical complete remission should be considered.
Commented on the article
.
"NEJM Medical Frontiers" translates several times a week, publishes them on the app and official website, and selects 2-3 articles to be published
on WeChat.
Copyright informationThis article was translated, authored or commissioned
by the Jiahui Medical Research and Education Group (J-Med) and the New England Journal of Medicine (NEJM), which is jointly developed by the New England Journal of Medicine (NEJM).
The full text of the Chinese translation and the charts contained therein are exclusively authorized
by NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement and the copyright owner reserves the right to
pursue legal liability.
Strong Pathologic Complete Response to Immunotherapy in MSI-High Esophagogastric Cancer patients with high MSI esophageal gastric cancer who receive immunotherapy to achieve a high rate of
pathological complete remission Reviewed by David H.
Ilson, MD, PhD
This landmark study shows that neoadjuvant therapy with ipimumab and navurizumab achieves high rates
of complete pathological response.
Immune checkpoint inhibitors have significant anticancer activity against various MSI-H (microsatellite unstable) cancers
.
It has recently been confirmed that these agents are more effective than chemotherapy
in the first-line treatment of MSI-H metastatic colorectal cancer.
Recent studies have also shown that patients with locally advanced colon and rectal cancer receive a high
rate of clinical and pathological complete remission with anti-PD-1 therapy.
French researchers reported the results of the GERCOR NEONIPIGA study, a single-group Phase 2 trial
evaluating locally advanced MSI-H esophageal gastric adenocarcinoma.
Patients received a total of 12 weeks of ipimuzumab (given every 6 weeks) and navurizumab (every 2 weeks) for a total of 12 weeks before surgery, followed by surgery followed by weekly adjuvant navulimumab for
9 months.
Of the 32 patients included in the trial, 72% were male, median age 65 years, the same number of patients with the primary lesion located in the gastric and gastroesophageal junction, 62% had cT3N+, and 22% had Lynch syndrome
.
Of the 29 patients undergoing surgery, the primary endpoint (pathological complete remission rate ≥20%) (17 patients; 58.
6%), and another 14% of patients had residual tumor cells ≤ 10%.
Of the 3 patients who did not undergo surgery, 2 patients who refused surgery but achieved a clinical complete response based on the record, and a third patient who also achieved a clinical complete remission was found to have metastatic M1 lymph node lesions at the time of the initial staging review
.
The R0 resection rate for surgical patients is 100%.
One patient died postoperatively, while the remaining 31 patients did not relapse
.
No new safety signals
appear.
Commenting on NEONIPIGA is a landmark study that shows that patients with MSI-H esophageal gastric adenocarcinoma achieve high pathological complete remission rates
after receiving neoadjuvant therapy with ipimumab and navurizumab.
Given the potential effect of preoperative chemotherapy on locally advanced MSI-H esophageal gastric cancer, neoadjuvant therapy with immune checkpoint inhibitors should be further investigated in this patient population, and non-surgical treatment
of patients with clinical complete remission should be considered.
Commented on the article
André T et al.
Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: The GERCOR NEONIPIGA phase II study.
J Clin Oncol 2022 Aug 15; [e-pub].
(https://doi.
org/10.
1200/JCO.
22.
00686)
NEJM Journal Collection
NEJM Journal Watch, published by NEJM Group, invites internationally renowned physicians to review important papers in the field of medicine and help physicians understand and apply the latest advances.
"NEJM Medical Frontiers" translates several times a week, publishes them on the app and official website, and selects 2-3 articles to be published
on WeChat.
Copyright informationThis article was translated, authored or commissioned
by the Jiahui Medical Research and Education Group (J-Med) and the New England Journal of Medicine (NEJM), which is jointly developed by the New England Journal of Medicine (NEJM).
The full text of the Chinese translation and the charts contained therein are exclusively authorized
by NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement and the copyright owner reserves the right to
pursue legal liability.
