Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update.

It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment.

它们旨在供临床医生自愿使用，并应与独立的专业判断一起使用。

Guidance may not be applicable to all patients, interventions, diseases, or stages of diseases.

该指导可能不适用于所有患者、干预措施、疾病或疾病阶段。

Guidance is based on review and analysis of relevant literature and is not intended as a statement of the standard of care.

该指导基于相关文献的回顾和分析，并不旨在作为照护标准的声明。

ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information.

美国临床肿瘤学会（ASCO）不支持第三方药物、设备、服务或疗法，并不对由此信息使用引起或相关的任何损害承担责任。

See complete disclaimer in Appendix 1 and Appendix 2 (online only) for more.

更多完整免责声明，请参见附录1和仅在线的附录2。

Background

To provide updated recommendations for immunotherapy and targeted therapy for patients with advanced gastroesophageal cancer.

为患有晚期胃食管癌的患者提供免疫治疗和靶向治疗的最新建议。

Methods

ASCO convened an Expert Panel to conduct a systematic reviewof relevant studies and develop recommendations for clinical practice.

美国临床肿瘤学会（ASCO）召集了一个专家组，对相关研究进行了系统审查，并为临床实践制定了建议。

Results

Twelve newly published or updated phase III randomized controlled trials met the inclusion criteria for the systematic review.

本系统综述纳入了12项新发表或更新的III期随机对照试验，符合纳入标准。

recommendations

The target population for these recommendations is patients with unresectable locally advanced, advanced, or metastatic gastroesophageal cancer.

这些建议的目标人群是无法手术的局部晚期、晚期或转移性胃食管癌患者。

Results from testing for actionable biomarkers should be available as soon as possible to inform treatment decision making.

应尽快获得可采取行动的生物标志物检测结果，以指导治疗决策。

Immunotherapy with doublet chemotherapy is recommended for patients with proficient mismatch repair (pMMR)/microsatellite stable (MSS) human epidermal growth factor receptor 2 (HER2)-negative gastroesophageal adenocarcinoma or squamous cell carcinoma and PD-L1 expression ≥1; patients with higher PD-L1 expression are more likely to benefit from immunotherapy.

对于错配修复功能正常（pMMR）/微卫星稳定（MSS）的人表皮生长因子受体2（HER2）阴性的胃食管腺癌或鳞状细胞癌患者，以及PD-L1表达≥1的患者，推荐使用双药化疗联合免疫治疗；PD-L1表达更高的患者更可能从免疫治疗中受益。

Zolbetuximab is recommended for patients with gastroesophageal adenocarcinoma, PD-L1 <1, and positive CLDN18.2 expression.

对于胃食管腺癌、PD-L1表达<1且CLDN18.2表达阳性的患者，推荐使用Zolbetuximab。

Patients with dual PD-L1 and CLDN18.2 positivity should engage in shared decision making, considering the factors outlined in the guideline.

具有PD-L1和CLDN18.2双重阳性表达的患者应参与共同决策，同时考虑指南中概述的因素。

Doublet chemotherapy alone is recommended for patients who are not positive for actionable biomarkers or are not considered candidates for targeted therapy or immunotherapy.

对于那些没有可行动的生物标志物阳性或不被认为是靶向治疗或免疫治疗候选者的患者，推荐单独使用双重化疗。

For patients with pMMR/MSS HER2-positive gastric/gastroesophageal junction (GEJ) adenocarcinoma, trastuzumab and doublet chemotherapy is recommended; for patients with PD-L1 expression ≥1, the addition of pembrolizumab is recommended.

对于具有pMMR/MSS HER2阳性胃/胃食管交界处（GEJ）腺癌的患者，推荐使用曲妥珠单抗和双重化疗；对于PD-L1表达≥1的患者，推荐添加派姆单抗。

Immunotherapy alone or with doublet chemotherapy is recommended for patients with mismatch repair deficient/microsatellite instability-high gastroesophageal cancer.

对于错配修复缺陷/微卫星不稳定性高（dMMR/MSI-H）的胃食管癌患者，推荐单独使用免疫治疗或与双药化疗联合使用。

Second-line therapy options include ramucirumab with paclitaxel, trastuzumab deruxtecan for HER2-positive gastric/GEJ adenocarcinoma, and immunotherapy for PD-L1 ≥1 esophageal squamous cell carcinoma after first-line combination chemotherapy without immunotherapy.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.

二线治疗方案包括雷莫芦单抗联合紫杉醇、曲妥珠单抗德曲妥珠单抗用于HER2阳性的胃/胃食管交界处腺癌，以及在一线联合化疗（不含免疫治疗）后对PD-L1≥1的食管鳞癌进行免疫治疗。