Choosing Chemotherapy and Immunotherapy for Advanced Cancer

Cancer-Specific Treatment Selection

The American Society of Clinical Oncology recommends nivolumab combined with fluoropyrimidine- and platinum-based chemotherapy for advanced gastroesophageal adenocarcinoma or squamous cell carcinoma with PD-L1 CPS ≥5 1, 2
For gastroesophageal cancer with PD-L1 CPS 1-5, consider nivolumab with fluoropyrimidine- and platinum-based chemotherapy on a case-by-case basis, weighing patient fitness and disease burden 1, 2
The National Comprehensive Cancer Network recommends fluoropyrimidine- and platinum-based chemotherapy alone without adding nivolumab for gastroesophageal cancer with PD-L1 CPS 0 1, 2
For HER2-positive gastric/GEJ adenocarcinoma, trastuzumab plus pembrolizumab combined with fluoropyrimidine- and oxaliplatin-based chemotherapy is recommended 1, 2
The European Society for Medical Oncology suggests nivolumab plus ipilimumab as an alternative option for esophageal squamous cell carcinoma with PD-L1 CPS ≥10 1, 2

The American Urological Association recommends enfortumab vedotin plus pembrolizumab as the preferred first-line treatment for metastatic urothelial carcinoma, demonstrating superior overall survival of 31.5 months versus 16.1 months with platinum-based chemotherapy (HR 0.47) 3, 4
For all eligible patients, enfortumab vedotin plus pembrolizumab achieves an objective response rate of 67.7% versus 44.4% with chemotherapy, with lower grade 3+ adverse events (55.9% vs 69.5%) 3, 4

The Society for Immunotherapy of Cancer recommends immune checkpoint inhibitors (anti-PD-1 or anti-CTLA-4 agents) as the preferred first-line treatment for advanced melanoma, based on superior survival outcomes 5

The National Comprehensive Cancer Network recommends fluoropyrimidine-based combination with oxaliplatin (FOLFOX/CAPOX) or irinotecan (FOLFIRI) as the first-line treatment for MSI-stable colorectal cancer 7
Bevacizumab addition increases survival and progression-free survival when combined with fluoropyrimidine-based chemotherapy 7
For KRAS wild-type tumors, add cetuximab or panitumumab to chemotherapy, as anti-EGFR antibodies are only active in KRAS wild-type disease 7

The College of American Pathologists recommends PD-L1 CPS, HER2 status (IHC and FISH), and MSI/dMMR status testing for gastroesophageal cancer 1, 2
The American Urological Association recommends FGFR2/3 genetic alterations testing for all patients with advanced urothelial carcinoma to identify erdafitinib candidates 4

The National Comprehensive Cancer Network recommends fluoropyrimidine (5-FU or capecitabine) plus platinum (cisplatin or oxaliplatin) as the preferred chemotherapy regimen for gastroesophageal cancer 1, 2, 8
For urothelial carcinoma, gemcitabine plus cisplatin is recommended for cisplatin-eligible patients, while gemcitabine plus carboplatin is recommended for cisplatin-ineligible patients 3, 4, 6

The Society for Immunotherapy of Cancer recommends prompt recognition and management of immune-related adverse events with corticosteroids, with 9% of patients requiring oral prednisone ≥40 mg daily 3
Regular monitoring for immune-related toxicities affecting skin, gastrointestinal tract, endocrine organs, liver, and lungs is necessary at each visit 3, 10

The American Urological Association recommends continuing avelumab maintenance within 4-10 weeks after completing first-line chemotherapy and until progression 3, 4
For chemotherapy, a fixed treatment period of 3-6 months is appropriate, with consideration for maintenance fluoropyrimidine alone if cumulative toxicity occurs and disease control is achieved 7