Dr. Waseem Abbas

Cancer Treatment Specialist
Director Research, Max Hospital, Shalimar Bagh

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Immunotherapy treatment for stomach, colon and esophageal cancer in India – Esophageal Cancer Specialist in Delhi | Patient Information

Gastro-Intestinal malignancies include cancer effecting esophagus, stomach, colon,liver and other organs of G.I tract. Esophageal cancer

Immunotherapy in early-stage Esophageal cancer

Treatment of localized non metastatic esophageal cancer is chemo plus radiation followed by surgery. Post chemo plus radiation response is very important. If response is poor from chemo plus radiation, prognosis of such patients remains poor because of high relapse rates. Recently nivolumab (Check point inhibitor) was approved for patients who have poor response to chemo plus radiation as adjuvant therapy for 1 year. Results look very promising which means these patients can survive longer with the help of immunotherapy

Stage 4 means non curable disease and chemotherapy is the only options and subsequently these patients develop resistance. Immunotherapy can be used now once chemotherapy fails to respond. It does not cure metastatic esophageal cancer but few patients live longer maintaining good quality og life.

Immunotherapy works well in patients who are MSI deficient and have high PDL 1.

Stomach Cancer

Treatment of stomach cancer depends on where the disease initiated and the extent of its spread throughout the body. If diagnosed early, surgery is the first-line treatment for stomach cancer, sometimes in combination with chemotherapy and/or radiation treatment. For advanced stomach cancer, treatment aims to stabilize disease progression and improve patients’ prognosis.

What is the benefit of Immunotherapy in stomach cancer?

Immunotherapy is used in stage 4 stomach cancer after chemotherapy stops working in patients with high PDL 1 and High MSI. Apart from that latest data has shown Immune check point inhibitors can be used upfront with immunotherapy for the treatment of stage 4 metastatic stomach cancer. This means that Immunotherapy can be used upfront for stomach cancer .

Drugs approved –

Nivolumab

Nivolumab can be used in people with advanced stomach cancer, typically along with chemotherapy

Pembrolizumab

Pembrolizumab can be used to treat advanced stomach cancer, typically after other treatments including chemotherapy have been tried, and if the cancer cells have any of the following:

At least a certain amount of the PD-L1 immune checkpoint protein

A high level of microsatellite instability (MSI-H) or a defect in a mismatch repair gene (dMMR)

A high tumor mutational burden (TMB-H), meaning they have many gene mutations

For people with advanced stomach cancer that tests positive for HER2, this drug can be used along with chemotherapy and immunotherapy.

Colon cancer

In colon cancer immunotherapy is not used in early stage. Immunotherapy is used for stage 4 colon cancer progressing on chemotherapy or along with chemotherapy.

Immunotherapy is highly effective upfront only if MSI is High (MSI-Deficient).

Pembrolizumab can be used as the first treatment for people with advanced or metastatic colorectal cancer. It is given as an intravenous (IV) infusion every 3 or 6 weeks.

Nivolumab can be used alone or with ipilimumab (see below) for people with metastatic colorectal cancer that has grown after treatment with chemotherapy.

CTLA-4 inhibitor

Ipilimumab (Yervoy) is another drug that boosts the immune response, but it has a different target. It blocks CTLA-4, another protein on T cells that normally helps keep them in check.

This drug can be used along with nivolumab (Opdivo) to treat colorectal cancer, but it’s not used alone. It is given as an intravenous (IV) infusion, usually once every 3 weeks for 4 treatments.

Rectal cancer-Immunotherapy for the treatment of rectum has same indication in rectal cancer as in colon cancer.