Canadian consensus recommendations: Advances in gastric cancer diagnosis and treatment

Picture (l-r): Fiona Singh, Champica Nicholas, Lyndsey Sousa, Erica Bagadiong, Cheryl Suarez, Andrea Beharry, Brandon Sheffield, Solome Basdeo, Keisha Ighovoyivwi, Kassandra Bisson and Ethan Francis

The field of gastric cancer care is evolving rapidly, bringing new hope to patients as well as some new challenges. With the introduction of targeted therapies and immunotherapies, such as anti-CLDN18.2 therapy, the role of pathologists is more important than ever. As Dr. Brandon Sheffield, a pathologist and researcher at the Osler Research Institute for Health Innovation (ORIHI), remarked, “Pathologists are playing a big part here, with Claudin18 becoming the latest immunohistochemistry (IHC) biomarker coming into play for precision medicine in gastric cancer patients.” The Claudin18 biomarker is a measurable indicator of gastric cancer.

A recently published report by a group of Canadian pathologists and oncologists provides recommendations on implementing biomarker testing to support personalized treatment in gastric and gastroesophageal junction (G/GEJ) cancers. These guidelines emphasize the importance of routine testing at the time of diagnosis (for biomarkers like HER2, MMR/MSI, PD-L1, and CLDN18). This testing is important for helping to identify patients that may be eligible for new and emerging therapies, and for improving outcomes in gastric cancer, a cancer type known to have poorer outcomes due to the late stage that diagnosis usually occurs.

The report also suggests ways to overcome challenges, stressing that collaboration between specialists, policymakers, and healthcare organization is needed to address barriers and ensure equitable access to care for patients. Noting the shortage of pathologists as a barrier, the recommendations stress the importance of providing ongoing training for lab staff and clinicians to help fill this need.

Patient advocates also highlight the importance of having biomarker testing available, since these results help patients to be matched appropriately with targeted therapies and immunotherapies. Clear communication between physicians and patients regarding test results and what that means for their treatment plans is another important factor identified.

“A lot has changed in gastric cancer, and we now have many new therapies to offer,” notes Dr. Sheffield. “ORIHI researchers are continuing to work with specialists across Canada to further refine this test and facilitate access to new therapies. Osler is pleased to be one of the first hospitals in Canada to offer this test to our patients.”