Flip the switch.
Top Line: Do patients with advanced gastric cancer benefit from switch maintenance immunotherapy?
The Study: Switch maintenance therapy implies switching to an alternative regimen in patients who respond to initial therapy. In JAVELIN Gastric 100, over 800 patients with advanced, HER2(-) gastric cancer received 12 weeks of induction therapy with FOLFOX or CAPEOX. If they had no progression (62% of the original cohort), they were randomized to continued chemotherapy or maintenance avelumab. There was no difference in median OS between maintenance chemo (10.9 months) and maintenance avelumab (10.4 months). Even among PD-L1(+) patients (which was only 12.4% of the entire cohort), there was no difference in OS (16.2 vs 17.7 months). Likewise, there was no improvement in median PFS with avelumab. There was a possible suggestion of benefit among patients with 1) no metastatic sites after induction or 2) MSI-high tumors. Remembering patients already had induction therapy, the (additional) overall response rate was ~14% in both arms. Among those few, response duration was numerically higher with avelumab than with chemotherapy.
TBL: Among unselected patients with advanced gastric cancer, there is no benefit to switch maintenance therapy with avelumab. | Moehler, J Clin Oncol 2020