ATTRACTION-2 gastric trials.

We just can’t get enough. Last week we lamented the failure of MacDonald’s MAGIC, but this week we celebrate last-ditch treatment options. The phase 3 ATTRACTION-2 trial tested nivolumab versus placebo for ~500 patients with advanced esophagogastric junction (EGJ) and gastric cancers failing at least two previous chemo regimens, and overall survival was improved by a little over one month with (at least third-line) nivolumab. Is this a game-changer? Probably not. First, this was a quantitatively small benefit among a very heterogeneous cohort. Second, this was conducted in an Asian population with widely-recognized unique (and uniquely favorable) outcomes with gastric cancer. But, loathe to lose a potential market, these Bristol-Myers Squibb-funded authors highlight “promising” survival outcomes in the phase 2 CheckMate-032 trial of combo ipilimumab + nivolumab for an analogous Western population. And they aren’t too timid to further extrapolate an expected benefit for Westerners from a reportedly increased rate of TILs among non-Asian path specimens. We'll let you decide for yourself if you want to put on your nivolumab goggles to make that leap of love.