Stomach cancer immunotherapy in the US: new lab test to improve metastases treatment

Oncologists at Wake Forest Baptist Medical Center (USA) are developing new lab test to improve diagnosis and stomach cancer immunotherapy, especially for metastases.

According to statistics, gastric carcinoma is #5 in morbidity and #3 in mortality among all malignant tumors.

About 730 000 people die from this cancer annually.

Over the past 40-50 years, changes in nutrition and improved methods of preserving foods significantly reduced the incidence of stomach cancer.

But treatment options, especially in the later stages of the disease, remain imperfect and ineffective. The five-year survival rate in most parts of the world does not exceed 30%.

This malignancy is one among the few diseases that are sensitive to biological response modifiers. Stomach cancer immunotherapy in the US is currently being tested in the leading clinical centers of the country including WFBMC Comprehensive Cancer Center.

At the metastatic stages, when malignant cells spread to distant organs, local doctors recommend surgical removal, chemotherapy, and radiation therapy. Immunotherapy is considered a relatively new, but very promising treatment option.

Immunotherapeutic agents activate patient’s own leucocytes to kill malignant cells or destroy their natural protective mechanisms (so-called inhibitors of immune checkpoints).

One of the current standards of immunotherapy is trastuzumab (Herceptin). This biological agent has proven to be highly effective in HER2-positive gastric carcinoma with metastases, alone or in combinations with standard chemotherapy.

Ramucirumab (Cyramza) is another biological agent based on highly selective antibodies against VEGFR 2. This drug is approved by the FDA for monotherapy or in combination with paclitaxel chemotherapy for the treatment of localized and metastatic stomach and gastroesophageal junction tumors.

Recently, American oncologists started using new drug pembolizumab (Keytruda), immune checkpoints inhibitors acting on the PD-1 signal pathway. This class prevents malignant cells from "hiding" from leukocytes, stopping the growth of advanced inoperable tumors.

According to WFBMC researchers, cancer immunotherapy provides promising results, but only 20-30% of patients respond well to innovative treatment.

Unique opportunities are limited by the absence of high-precision lab tests to predict an individual response to therapy.

This is the real bottleneck in modern oncology.

A new lab test will change the treatment of metastatic stomach cancer?

Recent study showed that the MUC16 gene mutation testing can significantly improve stomach cancer immunotherapy and diagnosis. It is associated with high mutational burden of the tumor and predicts adequate response to immunotherapeutic agents.

MUC16 mutations are also known as cancer antigen 125, or CA-125. This is a well-known biomarker, but its predictive value in gastric carcinoma remained a mystery for a long time.

Scientists from Wake Forest Baptist Medical Center in cooperation with their colleagues from China have made a discovery that may transform the diagnosis and immunotherapy of stomach cancer, especially in advanced cases.

Their research included hundreds of tissue samples from American and Asian bases. A detailed genetic analysis showed that the MUC16 mutation is very common in gastric carcinoma (22% in Asian samples and 38% in American samples).

JAMA Oncology reports that many of these samples contain additional mutations: disruption of genome integrity, replication, DNA repair, etc. MUC16 changes are associated with 87% higher mutational burden compared with "normal" carcinoma with unchanged MUC16.

What does this mean for cancer patients?

According to Professor Wei Zhang from WFBMC, the mutational burden may determine sensitivity to treatment. A simple lab test will tell oncologists whether it is worth spending precious patient’s time on complex treatment with immunotherapeutic agents.

Survival with a MUC16 mutation is 39% higher than with the “normal” tumor. Scientists note activation of immune response markers, immune checkpoints, replication and repair of cancer DNA in such malignant cells.

Dr. Zhang hopes that the MUC16 mutation gene will become a valuable biomarker and will eventually make gastric carcinoma treatment mush more effective. More research is needed to better understand the role of MUC16 in other malignancies.

Stomach Cancer Immunotherapy in the US: Wake Forest Baptist Medical Center

Baptist Medical Center at Wake Forest University in Winston-Salem (North Carolina) is one of America's best clinical and research institutions.

Cancer care is one of the WFBMC priorities.

In 2017, WFBMC Comprehensive Cancer Center was ranked #27 among US cancer clinics.

This is one of three similar centers in North Carolina.



Comprehensive Cancer Center is a motivated team of 120 experienced doctors who represent all areas of modern medicine: medical oncologists, radiation oncologists, abdominal surgeons. In addition to the standard treatment of gastric cancer, patients of the Center can take part in clinical trials studying experimental procedures and drugs. Scientists work on immunotherapy, cancer genetics, precision (personalized) medicine.

WFBMC doctors work as a multidisciplinary approach to improve stomach cancer treatment. Consensus therapy planning, based on the opinion of several specialists, gives the best possible results for each patient. This is the best opportunity to defeat cancer.

The current standard treatment in the early stages of the disease is surgical removal of tumor (partial or total gastrectomy). Adjuvant chemotherapy or radiation therapy improves treatment, reducing the risk of cancer recurrence after surgery.

Stomach cancer immunotherapy with modern biological agents significantly prolongs life of patients with metastases. The entire arsenal of American oncology is available: trastuzumab, pembrolizumab, ramucirumab, etc. Thanks to innovative laboratory tests, Wake Forest oncologists select the best therapeutic options to meet your needs.

High quality of life and 24/7 pain relief among the doctor’s high priorities when it comes to metastatic gastric carcinoma. Palliative procedures (such as stenting or bypass surgery) relieve symptoms. Powerful analgesics allow patients returning to normal daily activities.

Unfortunately, some cancers are still difficult to treat and prevent, but competent and compassionate Wake Forest doctors will do their best for you and your loved ones.

Before your appointment, we recommend to take medical record (translated into English), the results of laboratory tests and CT, MRI, X-ray (paper images or CD/DVD).

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator