GI Oncologists Discuss MATTERHORN Updates and Challenging HCC Subgroups
Key Points
- A follow-up analysis of the MATTERHORN trial supported the value of the durvalumab monotherapy maintenance treatment period of the regimen in patients with upper gastrointestinal (GI) cancers.
- Systemic therapy may still be feasible in patients with hepatocellular carcinoma (HCC) with Child-Pugh Class B liver function, although data to guide patient selection are very sparse.
GI medical oncologists Joseph McCollom, DO, of Parkview Cancer Institute, and Rachna Shroff, MD, MS, FASCO, of University of Arizona, reviewed the most recent update from the phase 3 MATTERHORN trial in gastric or gastroesophageal junction (GEJ) cancer, and considered the current treatment landscape for HCC subsets.
Previous presentations from the MATTERHORN study showed the addition of perioperative durvalumab to FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) significantly improved event-free survival (EFS) and overall survival in patients with resectable gastric or GEJ cancer. While the MATTERHORN regimen was approved and adopted as standard of care based on these findings, the necessity of the adjuvant durvalumab monotherapy treatment period has been debated.
At the 2026 American Society of Clinical Oncology Annual Meeting, authors presented an analysis of EFS outcomes in MATTERHORN by treatment period completion. The analysis reported EFS rates were greatest among patients who completed the full adjuvant regimen, supporting the value of the additional durvalumab monotherapy cycles. Overall, durvalumab improved EFS compared with FLOT alone across all treatment period completion subgroups.
For patients with newly diagnosed advanced HCC, there are three immunotherapy–based regimens: atezolizumab plus bevacizumab, nivolumab plus ipilimumab, and the STRIDE regimen (single tremelimumab regular interval durvalumab). However, these regimens were all evaluated in HCC with Child-Pugh Class A liver function, and guidance for patients with Child-Pugh Class B is lacking. Currently, limited cohort and retrospective data suggest select Class B patients may be able to tolerate systemic immunotherapy–based treatment, said Dr. Shroff.