Inclusion criteria, exclusion criteria and study summary
Surgery is the only curative option for patients with oesophagogastric adenocarcinoma, but despite the use of multimodality therapy which combines it with chemo and/or radiotherapy, more than 50% of patients will relapse and die. Many of the UK patients present with advanced disease which is already inoperable or metastatic at diagnosis. For these patients, standard care chemotherapy only offers them survival of less than a year. Nivolumab (a checkpoint blockade inhibitor) has been found to work in some advanced cancers. It is proposed for those where it hasn't worked - that these immunologically evasive tumours need to be sensitized to immunotherapy drugs to allow them to act. In this trial we will aim to sensitize the tumour with temozolomide (TMZ) to increase its sensitivity to nivolumab. Patients will be treated for up to 3 months with TMZ prior to commencing nivolumab either in conjuction with TMZ or alone.