Perioperative immunotherapy in gastric cancer in the spotlight

Table 4 Perioperative immunotherapy: Emerging data on perioperative immunotherapy in gastric and gastroesophageal junction adenocarcinoma

Trial name	Disease subtype	Strategy	pCR rate	EFS
GASPAR (2022)	G/GEJ adenocarcinoma	Perioperative FLOT + spartalizumab	Early data: Major response rate of 50%	Not reported yet
DRAGON (2024)	G/GEJ adenocarcinoma	Perioperative SOX ± camrelizumab + rivoceranib	18.3% (SOX + RC) vs 5.0% (SOX)	Not reported yet
			OR: 4.5; P < 0.001
VESTIGE (2020/2025)	G/GEJ adenocarcinoma	Adjuvant Ipi/Nivo vs adjuvant CT after neoadjuvant CT	Not an endpoint	11.4 months (Ipi/Nivo) vs 20.8 months (CT)
				HR: 1.55 (1.07-2.25); P = 0.99
ATTRACTION-5 (2024)	G/GEJ adenocarcinoma	Adjuvant CT (CAPOX or S-1) ± nivolumab	Not an endpoint	3-year RFS: 68.4% (nivolumab) vs 65.3% (CT)
				HR: 0.9 (0.69-1.18); P = 0.44
KEYNOTE-585 (2023)	G/GEJ adenocarcinoma	Perioperative CT (cisplatin-based or FLOT) ± pembrolizumab	12.9% (CT + pembrolizumab) vs 2.0% (CT)	44.4 months (CT + pembrolizumab) vs 25.3 months (CT)
			P < 0.00001	HR: 0.81 (0.67-0.99); P = 0.0198
			For dMMR/MSI: 38.1%	Did not meet the threshold for statistical significance (P = 0.0178)
DANTE (2024)	G/GEJ adenocarcinoma	Perioperative FLOT ± atezolizumab	24% (FLOT + atezolizumab) vs 15% (FLOT); P = 0.032	No data
			For CPS ≥ 10: 33% vs 12%
			For dMMR/MSI: 63% vs 27%
MATTERHORN (2024/2025)	G/GEJ adenocarcinoma	Perioperative FLOT ± durvalumab	19.2% (FLOT + durvalumab) vs 7.2% (FLOT)	2-year EFS: 67.4% vs 58.2% HR: 0.71 (0.58-0.86)
			RR: 2.69, (1.86-3.9), P < 0.00001	The difference between the groups in OS has not reached statistical significance

pCR: Complete pathological response; EFS: Event-free survival; G/GEJ: Gastric and gastroesophageal junction; FLOT: Fluorouracil, leucovorin, oxaliplatin, docetaxel; SOX: S-1 and oxaliplatin; RC: Rivoceranib + camrelizumab; OR: Odds ratio; Ipi/Nivo: Ipilimumab + nivolumab; CT: Chemotherapy; CAPOX: Capecitabine, oxaliplatin, docetaxel; RFS: Relapse-free survival; HR: Hazard ratio; CPS: Combined positive score; dMMR: Deficient mismatch repair; MSI: Microsatellite instability; EFS: Event-free survival; OS: Overall survival.