NCCN Guidelines for Gastric Cancers V.4.

2020 –Interim 12/11/20

Guideline Page Panel Discussion/References Vote

and Request
GASTRIC-F 3 of 14
Panel Member request to review
CheckMate 649 data regarding
nivolumab that was presented at
the 2020 European Society for
Medical Oncology (ESMO) Annual
Meeting for inclusion in the NCCN
Guidelines.
External Request:
Submission from Bristol Myers
Squibb (9/23/20) to review
nivolumab clinical data presented at
the 2020 European Society for
Medical Oncology (ESMO) Annual
Meeting and consider:
YES NO ABSTAIN ABSENT
Based on the review of the data and discussion, the panel consensus was 17 0 0 14
to include “fluoropyrimidine (fluorouracil or capecitabine), oxaliplatin, and
nivolumab (PDL1 CPS ≥ 5)” as a first-line treatment option for HER2
overexpression negative unresectable locally advanced, recurrent, or
metastatic disease. This is a category 1 (preferred) recommendation.
Reference
Moehler M, Shitara K, Garrido M, et al. Nivolumab plus chemotherapy
versus chemotherapy as first-line treatment for advanced gastric
cancer/gastroesophageal junction cancer/esophageal adenocarcinoma:
first results of the CheckMate 649 study. Oral Presentation presented at
the ESMO 2020 Annual Meeting; September 19-21, 2020; Virtual Meeting.

• the inclusion of nivolumab in

combination with FOLFOX or
CapeOX as a Category 1
treatment option for patients
with previously untreated,
unresectable, advanced or
metastatic gastric cancer
(GAST-F, page 3 of 14).
GASTRIC-F 3 of 14 Based on the review of the data and discussion, the panel consensus was 17 0 0 14
Panel Member request to review to remove ECF and ECF modifications (noted below) as treatment options
the data and category of evidence for unresectable locally advanced, recurrent, or metastatic disease. These
for ECF and ECF modifications. were listed under “Other Recommended Regimens”.
• ECF (epirubicin, cisplatin, and fluorouracil)
• ECF modifications
o Epirubicin, oxaliplatin, and fluorouracil
o Epirubicin, cisplatin, and capecitabine
o Epirubicin, oxaliplatin, and capecitabine