Treatment

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer

American Society of Clinical Oncology

Publication Date: Feb 26, 2026

Page Last Updated: Aug 13, 2026

Recommendation Rating Definitions

Quality of Evidence
Term		Definitions
H	- High	We are very confident that the true effect lies close to that of the estimate of the effect
M	- Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L	- Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL	- Very Low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation
Term		Definitions
S	- Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
W	- Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

GRADE Handbook, Schünemann, et al. 2013.

Document Overview

Document Title: Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Feb 26, 2026

Page Last Reviewed/Updated: Aug 13, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/full/10.1200/JCO-25-02958

Source Citation: Shah MA, Kennedy EB, Deighton D, et al. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update. J Clin Oncol. 2026 Feb 26. doi: 10.1200/JCO-25-02958

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The purpose of this guideline was to provide recommendations for the treatment of advanced gastroesophageal cancer that include targeted therapy and immunotherapy options in the first-line treatment setting and beyond for the overall population of patients with unresectable, incurable, metastatic gastroesophageal AC or SCC whose tumors express relevant predictive biomarkers.

Scope: Treatment

Diseases/Conditions (MeSH)

D000230 - Adenocarcinoma

D000077277 - Esophageal Squamous Cell Carcinoma

Keywords: Esophageal cancer, HER2, esophageal squamous cell carcinoma, gastric adenocarcinoma, human epidermal growth factor receptor 2, immunotherapy

Target Patient Population: Patients with advanced gastroesophageal cancer

Target Provider Population: Medical oncologists and other health care professionals

Inclusion Criteria: Male, Female, Adult, Older Adult

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Is immunotherapy or targeted therapy recommended as second-line or third-line treatment for advanced gastroesophageal AC?
Is immunotherapy or targeted therapy in combination with chemotherapy (CT) recommended as first-line treatment for advanced gastroesophageal AC or SCC for subgroups of patients who are HER2-negative and express PD-L1 as defined by TPS or CPS at cutoff levels of ≥ 1, ≥ 5, or ≥ 10?
Is immunotherapy or targeted therapy in combination with chemotherapy (CT) recommended as first-line treatment for advanced gastroesophageal AC or SCC for subgroups of patients who are HER2-negative and express PD-L1 as defined by TPS or those with HER2-positive gastric or GEJ AC?

Supplemental Methodology Resources: Evidence Tables Data Supplement

Number of Source Documents: 58

Literature Search Start Date: Thursday, December 31, 2009

Literature Search End Date: Thursday, March 3, 2022

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer

Treatment

Recommendation 1.1.

First-line Therapy

Recommendation 2.1.

Recommendation 2.2.

Recommendation 2.3.

Recommendation 2.4.

Recommendation 3.1.

Recommendation 3.2.

Recommendation 4.1.

Recommendation 4.2.

Recommendation 5.1.

Recommendation 5.2.

Second- or Third-line Therapy

Recommendation 6.1.

Recommendation 6.2.

Recommendation 6.3.

Recommendation Rating Definitions

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology