Tumours, immunotherapy advances: cures for oesophagus and stomach, plus lung

Early diagnosis, it is known, is a key objective for achieving the best results in oncology. But it is not always possible. There are even neoplastic forms that are unfortunately often recognised at an advanced stage, as is the case with the organs of the first digestive tract, and in particular the oesophagus and stomach, or the lung. This is why it is certainly important for patients to be able to benefit from new therapeutic approaches that, in cases indicated by cellular characteristics, can change the health trajectory and survival of those facing such complex oncological pathologies. And it is in this vein that good news is to be welcomed: the Italian Medicines Agency (AIFA) has approved the reimbursability of tislelizumab, an immunoncological drug, in these three forms of cancer.

The indications, with appropriateness also linked to the characteristics of the biomarkers, are obviously different: the treatment is indicated in combination with chemotherapy in the first line for oesophagus and stomach, and alone in the second line for oesophagus and lung (in this case we are talking about non-small-cell cancer, i.e. by far the most common form).

Oesophageal carcinoma affects around 2,350 people in Italia each year. AIFA's approval of the drug is in combination with chemotherapy for the first-line treatment of patients with unresectable, locally advanced or metastatic squamous cell carcinoma of the oesophagus with particular features of PD-L1 expression. "Alcohol consumption and cigarette smoking habits are closely linked to the squamous form, the most frequent," explains Filippo Pietrantonio, Head of Gastroenterological Medical Oncology at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan. "The two risk factors reinforce each other with a synergistic effect, so much so that the probability of falling ill increases up to 100 times in those who drink and smoke. In too many patients, around two thirds, the disease is detected at an already advanced stage, no longer operable. And they are very fragile people, often also affected by other diseases'. In the presence of the PD-L1 biomarker, the combination of tislelizumab plus chemotherapy showed a truly impressive benefit, as it almost doubled overall survival in comparison with chemotherapy alone. Not only that, AIFA also approved tislelizumab as monotherapy for patients with unresectable, locally advanced or metastatic squamous cell carcinoma of the oesophagus after previous chemotherapy.

In 2025, in Italia, an estimated 12,370 new cases of stomach cancer are expected: unfortunately less than 20% are detected at an early stage, so that only almost one third of patients survive five years. For gastric cancer, the drug has been approved in combination with chemotherapy for the first-line treatment of patients with HER2-negative, unresectable, locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma, whose tumours express PD-L1 with particular characteristics. "Advanced or metastatic gastroesophageal adenocarcinomas have received the same systemic treatment with chemotherapy and for more than 20 years there has been no real progress, especially in the forms that do not express the HER2 protein," the expert resumes. "The scenario is changing thanks to immunotherapy and the availability of tislelizumab in the first line broadens the treatment opportunities.

Immunotherapy is most effective when one biomarker, the PD-L1 protein, is expressed at high levels. It is therefore necessary, at the time of diagnosis of advanced disease, to immediately determine its expression level'. The advances in therapies for this disease, however, do not make it any less important for patients to have integrated management models that take into account the whole situation, starting with the nutritional aspect. "It is estimated that around 50% of stomach cancer patients are malnourished, a condition that leads to serious consequences, such as reduced tolerance to treatment, poorer survival and lower quality of life. Therefore, it is crucial that patients are always offered a nutritional status assessment and diet plans by nutritionists, which must be included in the multidisciplinary team'.