GI Malignancies Debate 2023 - Chicago | Perioperative immunotherapy and surgery for treating MSI-high esophagogastric tumors

Yelena Y. Janjigian, MD, Memorial Sloan Kettering Cancer Center, New York City, NY, provides insight into debates surrounding the management of upper GI malignancies that occurred at the Great Debates and Updates GI Malignancies Debate. With up to 20% of cases of early-stage esophagogastric tumors presenting with high microsatellite instability (MSI-high), its importance as a biomarker was a focus of discussion. Emphasis was placed on whether perioperative immunotherapy or perioperative chemotherapy was a more appropriate treatment for MSI-high tumors. In her opinion, the treatment options should be limited to perioperative immunotherapy and/or surgery. Perioperative chemotherapy-based regimens may increase the risk of adverse events and hence, complicate access to surgery for patients. This is problematic, as in over 80% of cases, surgery alone is enough to cure totally resectable MSI-high tumors, frequently making this the most effective option. If a less invasive option is sought, perioperative immunotherapies such as dual immune checkpoint blockade and monotherapy are recognized as being highly effective. These therapies may be able to achieve almost complete response and should be followed with continual monitoring and future surgery if necessary. This interview took place at the Great Debates and Updates GI Malignancies Debate in Chicago, IL.

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