Treatment of Advanced, Untreated HER2-Negative Gastric Cancer with PD-L1 CPS ≥5
This protocol covers the management of patients with advanced or metastatic gastric cancer who are treatment-naive, test HER2-negative, and whose tumours express PD-L1 at a combined positive score (CPS) of 5 or more — a biomarker threshold that defines eligibility for specific evidence-based regimens in this setting.
Clinical Scenario
Key selection criteriaThe qualifying population has advanced or metastatic disease, confirmed HER2-negative tumour status, no prior systemic therapy for advanced or metastatic disease, and a PD-L1 CPS of 5 or greater. Each of these criteria shapes which evidence-based options are indicated.
Treatment Approach
Recommended treatment for this scenario involves ramucirumab, with additional regimen options dependent on agent availability. The complete protocol — including full regimen details, sequencing, and decision criteria — is available below.
References
DOI: 10.1016/j.annonc.2022.07.004
NivolumabeChT is recommended for advanced, untreated gastric, OGJ and oesophageal cancer with a PD-L1 CPS 5 [I, A; ESMO-MCBS v1.1 score: 4].
Ramucirumabepaclitaxel is recommended for second-line treatment of gastric cancer [I, A; ESMO-MCBS v1.1 score: 2]. Ramucirumab monotherapy is also an option [I, B; ESMO-MCBS v1.1 score: 1].
Where ramucirumab is not available, paclitaxel, docetaxel or irinotecan monotherapy [I, A] or FOLFIRI [II, B] are recommended.
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