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Gastric Cancer — SCE Medical Oncology MCQ

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HardGI CancersGastric CancerSCE Medical Oncology

A fit patient has untreated unresectable HER2-negative gastric adenocarcinoma. PD-L1 combined positive score is 8 and the tumour is MSI-high. Which first-line regimen is directly supported by current NICE TA997 rather than extrapolated from biomarker subgroup data?

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Correct answer: A — Pembrolizumab with a platinum-fluoropyrimidine chemotherapy backbone under NICE TA997

TA997 recommends pembrolizumab with platinum- and fluoropyrimidine-based chemotherapy for untreated locally advanced unresectable or metastatic HER2-negative gastric or gastro-oesophageal junction adenocarcinoma with CPS at least 1. MSI-high status is prognostically and predictively important, but it does not turn later-line or subgroup evidence for pembrolizumab monotherapy into this first-line NICE recommendation. Trastuzumab requires HER2 positivity, and paclitaxel-ramucirumab is not the untreated-disease appraisal.

Reference: NICE TA997 pembrolizumab with platinum- and fluoropyrimidine-based chemotherapy for untreated HER2-negative gastric or gastro-oesophageal junction adenocarcinoma (Published July 2024): https://www.nice.org.uk/guidance/TA997/chapter/1-recommendations