Domvanalimab and zimberelimab in advanced gastric, gastroesophageal junction or esophageal cancer: a phase 2 trial.
Janjigian YY, Oh DY, Pelster M, Wainberg ZA, Prusty S, Nelson S, DuPage A, Thompson A, Koralek DO, Sison EAR, Rha SY
- DOI
- 10.1038/s41591-025-04022-w
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-20
Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/aa5225dc-0607-4531-b41f-bd06ad2b8e66 is authoritative.
How this rating was calculated
- CitationsCitations & links (capped) ×10−1★
- IntegrityIntegrity concern−0.5★
- ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
- ClaimsTreatment effect not shown to be clinically meaningful−0.5★
- ReportingStudy design partially met−0.25★
Citations & links are capped at −1★ combined, however many are flagged.
- 01Efficacy rests on an unvalidated surrogate endpoint
The primary efficacy endpoints are ORR, PFS, and OS. While OS is a hard clinical outcome, the primary endpoint is ORR (a surrogate), and the paper does not demonstrate target engagement at the tested dose (no PK/PD data) nor cite validated evidence linking ORR to long-term clinical benefit in this setting. The efficacy claim is based on tumor response and survival metrics without explicit validation of ORR as a surrogate for OS.
“The dual primary endpoints of safety and investigator-assessed ORR were evaluated in patients who enrolled and received any study treatment (treated analysis population).”
- 02Treatment effect not shown to be clinically meaningful
The reported ORR of 59% and median OS of 26.7 months are compared favorably to historical controls, but the effect size is not anchored to a minimal clinically important difference or a predefined threshold for clinical meaningfulness. The study is descriptive without formal hypothesis testing, and the magnitude of benefit is not explicitly justified as clinically material beyond statistical confidence intervals.
“Results from the EDGE-Gastric study arm A1 compare favorably with established first-line regimens of chemotherapy plus anti-PD-1 agents. Across pivotal phase 3 trials with nivolumab, pembrolizumab and tislelizumab, ORRs were 47–60%, median PFS was less than 8…”
This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.
This phase 2 open-label single-arm trial is well-conducted and clearly reported, with strong scientific premise, adequate ethics, resource identification, and data availability. The main weaknesses are the lack of randomization/blinding and formal power analysis, which are inherent to the phase 2 design but limit causal inference.
Both reviewers classified the study as interventional and agreed on all dimension statuses; no divergence required reconciliation. Non-applicable criteria (e.g., randomization, blinding, cell lines, housing) were excluded from scoring. The statistics verification component checked only 1 test (a CI) and found it consistent; other statistics were not machine-verified.
Numerical inconsistencies
1 finding · worst lowValues that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.
- Internal contradictions in the reported numbersAssessed
Recomputed 1 test: 1 consistent, 0 inconsistent; 1 via agent-written checks.
- CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 2Correlation between TAP and CPS
“There was correlation between TAP score and combined positivity score (CPS) ( r = 0.83, P < 0.0001).”
Taken as given: The correlation coefficient r=0.83 is a Pearson correlation.; The sample size n=41 is the number of patients with both TAP and CPS scores.; The p-value is two-tailed.Method: Two-tailed p-value for Pearson correlation with n=41 using t-distribution approximation.How we recomputed it: pR(0.83, 41)
- lowinternal contradictionThe subgroup counts in Table 2 (TAP≥1% n=29, TAP≥5% n=16, TAP<1% n=11) sum to 56, exceeding the overall N=41. This is explained by overlapping subgroups (TAP≥5% is a subset of TAP≥1%), but the table does not explicitly state this overlap.
“TAP ≥1% n = 29 | TAP ≥5% n = 16 | TAP <1% n = 11”
Table 2Find in source
Overstated conclusions
3 findings · worst highConclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.
- Efficacy rests on an unvalidated surrogate endpointAssessed
- Treatment effect not shown to be clinically meaningfulAssessed
- Conclusions only partially backed by the presented evidenceAssessed
4 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.
- partialReviewers 1, 2The Fc-silent design of domvanalimab may further optimize the therapeutic window by balancing efficacy with safety.The paper provides mechanistic rationale and safety data, but no direct comparative evidence to support the claim of optimization.Evidence: Discussion of Fc-silent design and safety profile.
“The Fc-silent design of domvanalimab may further optimize the therapeutic window by balancing efficacy with safety in the context of PD-1 blockade and chemotherapy.”
DiscussionFind in source - supportedReviewers 1, 2Dual TIGIT and PD-1 blockade with domvanalimab and zimberelimab plus chemotherapy demonstrated encouraging efficacy.The reported ORR of 59% and median OS of 26.7 months support the claim of encouraging efficacy, though the single-arm design limits comparison.Evidence: ORR 59% (90% CI 44.5-71.6%), median PFS 12.9 months, median OS 26.7 months.
“Dual TIGIT and PD-1 blockade with domvanalimab and zimberelimab plus chemotherapy demonstrated encouraging efficacy”
AbstractFind in source - supportedReviewers 1, 2The safety profile was consistent with that reported for anti-PD-1 plus platinum-based chemotherapy.The safety data (immune-related AEs 27%, grade ≥3 TEAEs 73%) are consistent with known profiles of such combinations.Evidence: Safety table shows TEAEs and immune-related AEs.
“the safety profile was consistent with that reported for anti-PD-1 plus platinum-based chemotherapy”
AbstractFind in source - supportedReviewers 1, 2Clinical activity was observed across PD-L1 subgroups.ORR and survival were reported for TAP≥1%, TAP≥5%, and TAP<1% subgroups, showing activity across all.Evidence: ORR 62% in TAP≥1%, 69% in TAP≥5%, 46% in TAP<1%.
Tumor responses were higher in TAP ≥1% and TAP ≥5% subgroups: ORR was 62% ... and 69% ... respectively
Resultsreviewer’s wording
Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.
- INADEQUATESurrogate endpointThe primary efficacy endpoints are ORR, PFS, and OS. While OS is a hard clinical outcome, the primary endpoint is ORR (a surrogate), and the paper does not demonstrate target engagement at the tested dose (no PK/PD data) nor cite validated evidence linking ORR to long-term clinical benefit in this setting. The efficacy claim is based on tumor response and survival metrics without explicit validation of ORR as a surrogate for OS.
“The dual primary endpoints of safety and investigator-assessed ORR were evaluated in patients who enrolled and received any study treatment (treated analysis population).”
- INADEQUATEEffect sizeThe reported ORR of 59% and median OS of 26.7 months are compared favorably to historical controls, but the effect size is not anchored to a minimal clinically important difference or a predefined threshold for clinical meaningfulness. The study is descriptive without formal hypothesis testing, and the magnitude of benefit is not explicitly justified as clinically material beyond statistical confidence intervals.
“Results from the EDGE-Gastric study arm A1 compare favorably with established first-line regimens of chemotherapy plus anti-PD-1 agents. Across pivotal phase 3 trials with nivolumab, pembrolizumab and tislelizumab, ORRs were 47–60%, median PFS was less than 8 months and median OS was 15 months or less.”
Data authenticity concerns
None foundAn adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.
Checked — nothing surfaced.
Reporting gaps
1 finding · worst mediumRequired detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.
- Study-design details incomplete (controls, blinding, power)Assessed
The introduction cites multiple prior studies (CheckMate 649, KEYNOTE-590, RATIONALE-305) and discusses the limitations of current therapies (median OS ~14 months, 17% survival beyond 3 years). It provides a logical rationale linking TIGIT/PD-1 dual blockade to enhanced antitumor immunity, supported by preclinical and early-phase clinical data. The paper also addresses limitations of prior research, such as the need for strategies to extend benefit beyond current standards.
The study is open-label (no blinding) and single-arm (no randomization), which is appropriate for a phase 2 proof-of-concept but limits rigor. The sample size justification is descriptive, not powered for hypothesis testing. Inclusion/exclusion criteria are described, and the analysis population (treated) is defined. Outlier handling is not explicitly addressed, but the analysis population is pre-specified. Controls are not applicable as there is no comparator arm. Independent replication is not applicable as this is a single trial.
“The study is open label, so investigators were not blinded to the allocation of enrolled patients.”
“The sample size justification was based on an estimation framework, and the study was designed for descriptive statistical analysis rather than formal statistical hypothesis testing with Type I error and power considerations.”
“Eligible patients were aged ≥18 years, had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1, and had not received previous systemic treatment for locally advanced or metastatic disease.”
“The study is open label, so investigators were not blinded to the allocation of enrolled patients.”
“The sample size justification was based on an estimation framework, and the study was designed for descriptive statistical analysis rather than formal statistical hypothesis testing with Type I error and power considerations.”
“Eligible patients were aged ≥18 years, had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1, and had not received previous systemic treatment for locally advanced or metastatic disease.”
The paper reports sex (24 male, 17 female), age range (30–82 years), and detailed demographics (race, country, ECOG PS, tumor characteristics). Sex is reported but not justified as single-sex (both sexes included). Age/weight/health are reported (age, ECOG PS). Species/strain and housing are not applicable. Demographics are comprehensive.
“This study included both male and female human participants ( n = 24 male and n = 17 female) aged 30–82 years.”
“Median age in years (range) | 62 (30–82)”
“This study included both male and female human participants ( n = 24 male and n = 17 female) aged 30–82 years.”
“Median age in years (range) | 62 (30–82)”
The paper states the study was conducted in conformance with the Declaration of Helsinki and other guidelines, and the protocol was approved by the local ethics committee at each site (Supplementary Table). All patients provided written informed consent. Regulatory compliance is stated. This meets the criteria for human research.
“The study was conducted in full conformance with the Declaration of Helsinki, the Council for International Organizations of Medical Sciences International Ethical Guidelines, institutional review board regulations and all other applicable local regulations.”
“All patients provided written informed consent before any study procedures; patients were not compensated monetarily for participation in this trial.”
“The study was conducted in full conformance with the Declaration of Helsinki, the Council for International Organizations of Medical Sciences International Ethical Guidelines, institutional review board regulations and all other applicable local regulations.”
The investigational products (domvanalimab, zimberelimab, FOLFOX components) are named with doses and regimens. The PD-L1 assay (VENTANA SP263) is identified with manufacturer. Statistical software (SAS 9.4) is identified. No antibodies, cell lines, or mycoplasma testing are applicable as this is a clinical trial.
“Tumor samples were stained using the VENTANA PD-L1 (SP263) companion diagnostics assay (Roche Diagnostics).”
“Statistical analyses were performed using SAS software, version 9.4.”
“patients with no prior systemic treatment for locally advanced or metastatic GC/GEJC/EAC received intravenously administered domvanalimab 1,600 mg and zimberelimab 480 mg once every 4 weeks with FOLFOX”
“Tumor samples were stained using the VENTANA PD-L1 (SP263) companion diagnostics assay (Roche Diagnostics).”
“Statistical analyses were performed using SAS software, version 9.4.”
The paper uses Kaplan-Meier for survival, Clopper-Pearson for ORR, and reports 90% CIs. Exact p-values are not reported for efficacy endpoints (only for correlation), but the analysis is estimation-based, which is acceptable. Effect sizes (ORR, PFS, OS) are reported with CIs. Software is identified. Data presentation includes Kaplan-Meier curves and tables with per-group n. Mathematical plausibility checks: the subgroup counts (29+16+11=56) exceed the overall N=41, but this is explained by overlapping subgroups (TAP≥1% includes TAP≥5%), so not an inconsistency.
“Median OS, median PFS, median DOR, PFS rate at 24 months and OS rate at 24 months were estimated using the Kaplan–Meier method.”
“the confirmed objective response rate was 59% (90% confidence interval (CI) 44.5–71.6%)”
“Parameter | Overall N = 41 a | TAP ≥1% n = 29 | TAP ≥5% n = 16 | TAP <1% n = 11”
“Median OS, median PFS, median DOR, PFS rate at 24 months and OS rate at 24 months were estimated using the Kaplan–Meier method.”
“the confirmed objective response rate was 59% (90% confidence interval (CI) 44.5–71.6%)”
“TAP ≥1% n = 29 | TAP ≥5% n = 16 | TAP <1% n = 11”
The data availability statement provides a concrete route: de-identified individual participant data may be available upon request via a transparency policy link, with conditions and timeframe. This is adequate for a clinical trial. Repository deposit and accession numbers are not applicable for patient-level data. Code sharing is not applicable as no bespoke code is mentioned.
“Summary and de-identified individual participant data as well as other trial information (protocols, statistical analysis plans and clinical study reports) may be available upon request.”
“For information on the process or to submit a request, see https://trials.arcusbio.com/our-transparency-policy”
“Requests for data from any qualified researcher who engages in rigorous, independent scientific research will be considered if the clinical trial data are not part of an ongoing or planned regulatory submission.”
“For information on the process or to submit a request, see https://trials.arcusbio.com/our-transparency-policy”
The trial is registered (NCT05329766). A reporting guideline is not explicitly mentioned, but the paper follows Nature Portfolio reporting standards. All outcomes are reported, including negative results (e.g., TAP<1% subgroup). Limitations are discussed (sample size, open-label, assay heterogeneity). Conclusions are proportional, noting the need for phase 3 validation. Funding and COI are disclosed.
“ClinicalTrials.gov identifier: NCT05329766”
“EDGE-Gastric is a proof-of-concept, open-label phase 2 study, with limitations related to sample size, study design and assay heterogeneity.”
“This work was supported by Arcus Biosciences, Inc. and Gilead Sciences, Inc.”
“ClinicalTrials.gov identifier: NCT05329766”
“EDGE-Gastric is a proof-of-concept, open-label phase 2 study, with limitations related to sample size, study design and assay heterogeneity.”
“This work was supported by Arcus Biosciences, Inc. and Gilead Sciences, Inc.”
Registered (2 IDs: ClinicalTrials.gov). No reporting guideline cited.
Broken references and links
1 finding · worst lowReferences checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.
- References not resolvable to a published paperRecomputed
Checked 30 references by DOI: 20 verified — 10 DOI unresolved.
- UNRESOLVED10.1016/s0140-6736(21)01278-2Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 studyCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1016/s1470-2045(23)00415-6Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for HER2-negative advanced gastric cancer (KEYNOTE-859): a multicentre, randomised, double-blind, phase 3 trialCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1001/jama.2023.21318Sintilimab plus chemotherapy for unresectable gastric or gastroesophageal junction cancer: the ORIENT-16 randomized clinical trialCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1073/pnas.0904624106The interaction of TIGIT with PVR and PVRL2 inhibits human NK cell cytotoxicityCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1200/jco.2022.40.16_suppl.397600ARC-7: randomized phase 2 study of domvanalimab + zimberelimab ± etrumadenant versus zimberelimab in first-line, metastatic, PD-L1-high non-small cell lung cancer (NSCLC)Cited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1136/ijgc-2023-004700Efficacy and safety of zimberelimab (GLS-010) monotherapy in patients with recurrent or metastatic cervical cancer: a multicenter, single-arm, phase II studyCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1136/jitc-2024-sitc2024.1690Phase 2 randomized study of domvanalimab combined with zimberelimab in front-line, PD-(L)1 high, locally advanced or metastatic non-small cell lung cancer (NSCLC): results from ARC-10 part 1Cited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1007/s00262-025-03912-5Anti-TIGIT therapies: a review of preclinical and clinical efficacy and mechanismsCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1186/s12943-024-02156-8Regulatory T cells in immune checkpoint blockade antitumor therapyCited DOI does not resolve to any Crossref record.
- UNRESOLVED10.1186/s13000-023-01333-5Tumor area positivity (TAP) score of programmed death-ligand 1 (PD-L1): a novel visual estimation method for combined tumor cell and immune cell scoringCited DOI does not resolve to any Crossref record.
1 data/code link checked; 1 live.
- datahttps://trials.arcusbio.com/our-transparency-policyLIVEHTTP 200Resolves, but the content could not be matched to the paper.
Copyediting
5 minorWording, consistency and formatting errors that need correcting before submission.
No major wording or formatting errors. 5 minor suggestions below.
5 copyedit issues flagged: mostly consistency, clarity, other.
- MINORconsistencyAbstract“tumor area positivity ≥1% (PD-L1 positive) and tumor area positivity ≥5% (PD-L1 high)”→ Consider defining TAP abbreviation at first use in abstract.TAP is defined later in the main text.
- MINORclarityMethods, Study design“The study is open label, so investigators were not blinded to the allocation of enrolled patients.”→ Consider rephrasing to 'The study was open-label; therefore, investigators and patients were not blinded to treatment allocation.'Clarifies that patients were also unblinded.
- MINORotherData availability“https://trials.arcusbio.com/our-transparency-policy (https://nam12.safelinks.protection.outlook.com/?url=...)”→ Use a clean, non-redirected URL.The long safelinks URL is unwieldy.
- MINORconsistencyAbstract“NCT05329766 (https://clinicaltrials.gov/study/NCT05329766?term=Quemliclustat&rank=5)”→ Remove the query parameters from the URL to avoid confusion.The URL includes a search term 'Quemliclustat' which is unrelated to the trial.
- MINORclarityDiscussion“These observations are being further investigated in the ongoing, randomized, phase 3 STAR-221 trial ( NCT05568095 (https://clinicaltrials.gov/ct2/show/NCT05568095) )”→ Ensure the URL is formatted consistently with other URLs.Minor formatting inconsistency.
The published work is robust for a phase 2 proof-of-concept, but readers should weigh the lack of a comparator arm and formal power analysis when interpreting effect sizes. No erratum is warranted based on the rigor review; however, the 10 references not found in registries should be verified to rule out fabrication, and minor copyedit issues (URLs, TAP abbreviation) could be corrected in a revision.
- 1.HIGHreportingVerify the 10 references flagged as 'not_found_in_registry' (e.g., KEYNOTE-590, KEYNOTE-859, ORIENT-16, ARC-7, ARC-10, and others) by checking their DOIs in Crossref/PubMed, and correct or replace any that are erroneous or fabricated.References that cannot be located in any registry are a fabrication signal and must be resolved before the paper can be trusted.
- 2.HIGHreportingAdd an explicit statement in the Methods (Statistical analysis) on how missing data and outliers were handled, even if none were excluded.Both reviewers noted outlier_handling is not reported; transparency about data handling is expected for clinical trials.
- 3.HIGHreportingExplicitly mention adherence to a reporting guideline (e.g., CONSORT) in the Methods or Reporting Summary.The paper does not explicitly state a reporting guideline, which is a minor gap in reporting transparency.
- 4.MEDIUMreportingClarify the sample size justification by stating the expected precision or target width of the confidence interval for ORR.The estimation framework is described but lacks a concrete precision target, which would strengthen the power_analysis sub-criterion.
- 5.MEDIUMreportingIn the Discussion, explicitly acknowledge the lack of a comparator arm as a limitation and discuss potential confounding.The single-arm design is a key limitation that should be explicitly discussed to help readers interpret the results.
- 6.MEDIUMreportingReport the number of patients with PD-L1 status assessed by central lab versus local lab, as one patient had no central tissue.This would improve transparency in subgroup analyses and clarify the assay heterogeneity limitation.
- 7.MEDIUMcopyeditDefine the TAP abbreviation at first use in the Abstract.TAP is used in the abstract but only defined later in the main text, which may confuse readers.
- 8.MEDIUMcopyeditReplace the long safelinks URL in the Data availability section with the clean, non-redirected URL.The current URL is unwieldy and may be broken or misleading.
- 9.MEDIUMcopyeditRemove the query parameters from the ClinicalTrials.gov URL in the Abstract (e.g., '?term=Quemliclustat&rank=5') to avoid confusion.The URL includes an unrelated search term that could mislead readers.
- 10.LOWcopyeditRephrase the open-label statement in Methods to clarify that both investigators and patients were unblinded.The current phrasing only mentions investigators, which is ambiguous.
- 11.LOWcopyeditEnsure the STAR-221 trial URL in the Discussion is formatted consistently with other URLs.Minor formatting inconsistency in the URL.
The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”
- Reporting — 8 dimensionseach dimension that fully fails−½★
- each dimension partially met−¼★
- Statistics · Integrity · Claimseach serious problem−1★
- each medium problem−½★
- Citationseach retracted or unverifiable reference−¼★
- Copyeditonly when the manuscript needs a full edit−½★
The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.
The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.
Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.
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