Keypoints:
• Early Disease Management: perioperative FLOT versus concurrent chemoradiation.
• Adjuvant Nivolumab: Insights from the Checkmate 577 trial and its implications for patients with residual disease post-chemoradiation.
• Biomarker Testing: The importance of testing for MSI, HER2, Claudin 18.2, and PD-L1 to guide treatment decisions in metastatic settings.
• Patient-Centered Care: Emphasizing the significance of shared decision-making and multidisciplinary approaches in managing complex cases.
In this episode of the Oncology Brothers, Drs. Rahul & Rohit Gosain, along with Dr. Timothy Brown from UT Southwestern, delve into the complexities of upper gastrointestinal malignancies, specifically focusing on esophageal and gastroesophageal junction adenocarcinoma, as well as gastric cancer.
Discussion kicked off by outlining the treatment paradigms for early-stage disease, emphasizing the standard of care for T1 tumors, which is upfront surgery followed by surveillance. For T2 or node-positive cases, we explored the evolving role of medical oncologists, particularly in light of recent data from the ESOPEC study with periop FLOT regimen vs. chemoRT approach. Dr. Brown highlighted the superiority of perioperative FLOT over traditional chemoradiation, noting its benefits in overall survival and progression-free survival.
As we transitioned to the topic of adjuvant nivolumab, we discussed its application in patients with residual disease post-chemoradiation, emphasizing the importance of patient-specific decision-making. We also touched on the significance of biomarker testing, including MSI status and HER2 expression, which are crucial for guiding treatment in metastatic settings.
In the metastatic space, Dr. Brown outlined his current treatment approach, stressing the importance of testing for four key biomarkers: MSI or MMR, Claudin 18.2, HER2 status, and PD-L1. We discussed the promising results of new therapies, including zolbetuximab and trastuzumab deruxtecan, and the need for careful management of side effects, particularly with novel agents.
Finally, we addressed the challenges of treating oligometastatic disease and the limited options available in the second-line setting, underscoring the need for ongoing research and clinical trials.
Overall, this episode provides valuable insights into the latest treatment algorithms and the importance of personalized care in managing upper GI malignancies. Thank you for joining us, and we look forward to sharing more updates and discussions in future episodes!
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