ArticleFrontiers in oncology2026
Continuing immune checkpoint inhibitors beyond progression versus switching to non-ICI therapy in advanced gastric cancer: a real-world study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The optimal second-line therapy for advanced gastric/gastroesophageal junction cancer (GC/GEJC) following progression on first-line immuno-chemotherapy remains undefined. This study aimed to compare the efficacy and safety of continuing an immune checkpoint inhibitor beyond progression (CIBP) versus switching to a non-ICI regimen (non-CIBP). Methods: In this single-center, retrospective study, we enrolled 169 patients with GC/GEJC who progressed after first-line ICI plus chemotherapy. Based on the second-line therapeutic decision, patients were categorized into either the CIBP group (n=120; to continue ICI with or without combined therapy) or the non-CIBP group (n=49; to switch to a non-ICI regimen). The primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: The CIBP group demonstrated significantly improved median PFS (4.4 vs. 3.0 months; hazard ratio [HR]=0.47, 95% CI: 0.33-0.67; p<0.001) and median OS (9.5 vs. 6.4 months; HR = 0.51, 95% CI: 0.34-0.77; p=0.0012) compared to the non-CIBP group. The survival benefit of CIBP remained robust after multivariable adjustment (PFS HR = 0.54, p=0.003; OS HR = 0.65, p=0.044) and propensity score matching. Subgroup analyses revealed that patients with PD-L1 expression ≥1%, those who achieved an objective response to first-line therapy, or those with a first-line PFS ≥6 months derived the greatest benefit from CIBP. The safety profile was manageable and comparable between the two groups. Conclusion: In this real-world cohort, continuing ICI beyond progression was associated with significantly superior survival outcomes compared to switching to non-ICI regimens, with a manageable safety profile. CIBP represents a valid and promising second-line strategy for selected patients with advanced GC/GEJC following first-line immuno-chemotherapy failure.
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