Advanced upper GI cancer overview
Current treatments for upper GI cancers like ESCC and GC/GEJC show limited median overall survival. With patients facing debilitating symptoms, there is a significant need for new 1L treatment options that can extend survival, a need TEVIMBRA aims to address.
Recent phase 3 trials underscore unmet needs1-4
In 1L ESCC:
- <14 months mOS in patients with a positive PD-L1 score receiving immunotherapy and chemotherapy combinations, or chemotherapy alone, in phase 3 clinical trials1-4*
- Patients with advanced or metastatic ESCC also face debilitating symptoms, such as dysphagia, which can lead to cachexia5,6
In 1L HER2- GC/GEJC:
- ≤14 months mOS in patients with a positive PD-L1 score receiving immunotherapy and chemotherapy or chemotherapy alone in pivotal trials1,2,4†
- ~50% of patients present with peritoneal metastases, a poor prognostic factor. It is difficult for patients with peritoneal metastases to remain on treatment, and no phase 3 trial of immunotherapy has reported positive survival using a PD-L1 score cutoff of ≥1%,‡ potentially owing to the immunosuppressive, macrophage-rich environment in the peritoneum7-14
In 1L ESCC:
- Less than 14 months mOS in patients with a positive PD-L1 score receiving immunotherapy and chemotherapy combinations, or chemotherapy alone, in phase 3 clinical trials*
- Patients with advanced or metastatic ESCC also face debilitating symptoms, such as dysphagia, which can lead to cachexia
In 1L GC/GEJC:
- 14 months or less mOS in patients with a positive PD-L1 score receiving immunotherapy and chemotherapy or chemotherapy alone in pivotal trials†
- Despite the difficulty in detecting widespread disease, it is estimated that ~50% of patients present with peritoneal metastases. It is difficult for patients with peritoneal metastases to remain on treatment, and no phase 3 trial of immunotherapy has reported favorable survival using a PD-L1 score cutoff of ≥1%,‡ potentially owing to the immunosuppressive, macrophage-rich environment in the peritoneum
Patients with certain advanced or metastatic upper GI cancers need 1L treatment options that can extend survival further
Patients with certain unresectable or metastatic upper GI cancers need 1L treatment options that can extend survival further
Frequently Asked Questions
Historically, how have patients with 1L HER2- advanced GC/GEJC and peritoneal metastases responded to immunotherapy + chemotherapy?
*Phase 3 clinical trials include CHECKMATE-648, KEYNOTE-590, and REAL-2. Median overall survival of less than 14 months represents analyses of patients with CPS scores ≥1.1,2,4
†Pivotal trials include CHECKMATE-649, KEYNOTE-859, and REAL-2. Median overall survival of 14 months or less represents analyses of patients with CPS scores ≥1.1,2,4
‡Phase 3 clinical trials include ATTRACTION-04, CHECKMATE-649, and KEYNOTE-859.
1L, first line; CPS, combined positive score; ESCC, esophageal squamous cell carcinoma; GC, gastric cancer; GEJC, gastroesophageal junction cancer; GI, gastrointestinal; mOS, median overall survival; PD-1, programmed death receptor 1; PD-L1, programmed death ligand 1.
References: 1. Keytruda. Prescribing Information. Merck & Co. Inc.; 2026. 2. Opdivo. Prescribing Information. Bristol-Myers Squibb Company; 2026. 3. Doki Y, Ajani JA, Kato J, et al; CheckMate 648 Trial Investigators. N Engl J Med. Supplementary appendix. 2025;386(5):449-462. doi:10.1056/NEJMoa2111380 4. Cunningham D, Starling N, Rao S, et al. N Engl J Med. 2008;358(1):36-46. doi:10.1056/NEJMoa073149 5. Early detection, diagnosis, and staging of esophageal cancer. American Cancer Society. Updated August 14, 2025. Accessed February 25, 2026. https://www.cancer.org/cancer/types/esophagus-cancer/detection-diagnosis-staging.html 6. Brown LR, Laird BJA, Wigmore SJ, et al. Curr Treat Options Oncol. 2022;23(12):1732-1747. doi:10.1007/s11864-022-01028-1 7. Bootsma S, Bijlsma MF, Vermeulen L. EMBO Mol Med. 2023;15(3):e15914. doi:10.15252/emmm.202215914 8. Kang D, Kim IH. Biomedicines. 2022;10(6):1376. doi:10.3390/biomedicines1006136 9. Van Wagoner CM, Rivera-Escalera F, Jaimes-Delgadillo NC, Chu CC, Zent CS, Elliott MR. Immunol Rev. 2023;319(1):128-141. doi:10.1111/imr.13265 10. Rha SY, Oh DY, Yañez P, et al; KEYNOTE-859 Investigators. Lancet Oncol. 2023;24(11):1181-1195. doi:10.1016/S1470-2045(23)00515-06 Published correction appears in Lancet Oncol. 2024;25(12):e626. doi:10.1016/S1470-2045(24)00650-8 11. Janjigian YY, Shitara K, Ajani JA, et al. Ann Oncol. 2026;37(6):787-797.doi:10.1016/j.annonc.2026.02.003 12. Coccolini F, Gheza F, Lotti M, et al. World J Gastroenterol. 2013;19(41):6979-6994. doi:10.3748/wjg.v19.i41.6979 13. Shitara K, Moehler M, Ajani J, et al. Poster presented at: American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 18-20, 2024; San Francisco, CA. Poster Bd E6. 14. Verstegen MH, Harker M, van de Water C, et al. World J Gastroenterol. 2020;26(39):6037-6046. doi:10.3748/wjg.v26.i39.6037