Immunotherapy Considerations for Upper GI and Esophageal Cancer Treatment Pathways

EP: 1.Prevalence and Characteristics of GI Cancers

EP: 2.Evolving Treatment Landscape for Upper GI and Esophageal Cancer

EP: 3.KEYNOTE-590 Trial Impacting Treatment Landscape for ESCC and Upper GI Cancer

EP: 4.Overview of CheckMate Trials 648 and 649

EP: 5.Aligning ESCC and GI Cancer Treatment Strategies With Current Guidelines

EP: 6.Quality of Life Impacted by Treatment of ESCC and Upper GI Cancer

EP: 7.Optimizing Treatment Pathways for Patients with ESCC and GI Cancer

EP: 8.The Evolving Treatment Landscape of Upper GI and Esophageal Cancer

EP: 9.Key Cost Drivers in Treating Gastroesophageal Cancers

EP: 10.Unmet Needs for Patients With Esophageal and Upper-GI Cancers

EP: 11.Role of Immune Checkpoint Inhibitors in Gastroesophageal Cancer Treatment Landscape

EP: 12.Decision-Making Within a Rapidly Evolving Field Where Labeling May Differ From Current Clinical Guidelines

EP: 13.Determining Individual Treatment Sequencing for Patients with Gastroesophageal Cancer

EP: 14.Selecting Optimal Gastroesophageal Treatment: Chemotherapy, Immunotherapy, and Combined Therapies

EP: 15.New Gastroesophageal Treatment Therapies Impacting Patient Quality of Life

EP: 16.Defining Appropriate Response to Gastroesophageal Cancer Treatment

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EP: 17.Immunotherapy Considerations for Upper GI and Esophageal Cancer Treatment Pathways

EP: 18.Evaluating Gastroesophageal Cancer Pathway Decisions

EP: 19.Cost-Effective Analyses for Upper GI and Esophageal Cancer Treatment

EP: 20.Patient-Support Services and Programs for Patients With Gastroesophageal Cancer

James M. Cleary, MD, PhD: Increasingly, hospitals—including mine—have pathways that tell us what the recommended treatments are for our patients at a certain course in their illness. At my hospital, we have to enter it in and show that we’re using the pathways. If we aren’t using the pathways, [we have to] give a justification for why we aren’t. This has been a good thing. I’m always incredibly impressed by community oncologists who have to take care of everything. They have to be up to date with breast cancer, lymphoma, leukemia, and gastroesophageal cancer. I don’t know how they do it. By having pathways, it helps people [keep] up with research and know what the experts in the field are recommending. For oncology in general, having these pathways has been a great advantage.

Laura Bobolts, PharmD, BCOP: Pathways may be employed at times with patients with upper GI [gastrointestinal] and esophageal cancers. Why is that? Because there are so many options in the market. A pathway is selecting a subset of treatment regimens, typically based on national guidelines such as NCCN [National Comprehensive Cancer Network], but you’re going a level deeper. You aren’t looking at only the efficacy. You’re also looking at the toxicity and the total cost of care, including resource utilizations. Is this patient more likely to need more supportive care medications on this regimen vs another?

A pathway selects a subset of regimens to reduce variation in care, align therapy with evidence-based medicine, and provide a metric to measure oncologists for high-quality, cost-effective cancer care. But we must also keep in mind that there are unique patients. Not every patient fits into a pathway bubble, but pathways fit into the treatment of these cancers. If you look at the NCCN, in the first-line setting of esophageal and GEJ [gastroesophageal junction] cancers, there are 18 options bulleted. The options may vary based on biomarkers, but there are 18 options to consider. When you look at gastric cancer, NCCN bullets 14 options in the first-line setting. That isn’t getting into second-line or later treatment.

Having all those available options introduces a possibility of variability in cancer care and, from what I’ve seen on the managed care side, using therapies in different lines than the evidence-based medicine may align with. A pathway can be leveraged to incentivize the use of therapy where the evidence aligns.

Transcript edited for clarity.