Perioperative immunotherapy goes global in gastro-oesophageal cancer
Mené sur 948 patients atteints d'un adénocarcinome de l'estomac ou de la jonction oesogastrique (âge médian : 62 ans), cet essai multicentrique de phase III évalue l'efficacité, du point de vue de la survie globale, et la toxicité d'un traitement péri-opératoire combinant durvalumab et chimiothérapie de type FLOT (fluorouracile, leucovorine, oxaliplatine et docétaxel)
Gastric and gastro-oesophageal junction cancers are among the most common causes of cancer-related deaths.1 In patients with operable tumours, several phase 3 trials established the value of perioperative chemotherapy.2–4 In parallel, phase 3 studies in advanced disease confirmed a survival advantage for anti-PD-1 and anti-PD-L1 immune checkpoint inhibitors in combination with platinum doublet chemotherapy, particularly in PD-L1 expressing tumours.5 Thus, examination of whether immune checkpoint inhibitors could improve outcomes in patients who are non-metastatic was warranted. The MATTERHORN trial was the first to show the combination of perioperative durvalumab (anti-PD-L1 antibody) plus fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) improved event-free survival versus standard perioperative FLOT.6 This study enrolled 948 patients (median age 62 years [IQR 54–68], 266 [28%] female, 682 [72%] male, and 180 [19%] from Asia), but there was no accrual from China, which represents approximately 40–50% of global gastric cancer cases.7 Although MATTERHORN showed a clear improvement in event-free survival for durvalumab plus FLOT over placebo plus FLOT (hazard ratio [HR] 0·71, 95% CI 0·58–0·86; p<0·0001),6 and has been widely adopted, questions remained about durvalumab's impact on overall survival and benefit in specific pathological subgroups.
The Lancet , commentaire, 2026