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Gastric Cancer — SCE Medical Oncology MCQ

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HardGI CancersGastric CancerSCE Medical Oncology

A patient with untreated HER2-negative metastatic gastric adenocarcinoma is being assessed for nivolumab plus platinum-fluoropyrimidine chemotherapy under NICE TA857. Which single change would make the tumour ineligible for that recommendation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Repeat validated testing reports a PD-L1 combined positive score of 4

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

C is correct. NICE TA857 requires untreated HER2-negative advanced gastric, gastro-oesophageal junction or oesophageal adenocarcinoma with a PD-L1 combined positive score of at least 5. A confirmed CPS of 4 therefore falls outside this recommendation. Gastric and junctional primaries are both covered, and unresectable locally advanced as well as metastatic disease can qualify. FOLFOX and capecitabine-oxaliplatin are accepted platinum-fluoropyrimidine backbones, with nivolumab started as part of the first-line combination rather than reserved for maintenance or progression. The result must come from validated testing on representative tumour material.

Reference: NICE TA857 nivolumab with chemotherapy recommendations: https://www.nice.org.uk/guidance/ta857/chapter/1-Recommendations