In this episode of the Oncology Brothers podcast, we were joined by Dr. Sam Klempner, a medical oncologist specializing in upper GI malignancies. The focus of the discussion was on treatment strategies for upper GI adenocarcinomas, specifically esophageal, GE junction, and gastric cancers.
Dr. Klempner highlighted the importance of staging, imaging, endoscopy, pathology, and biomarkers in guiding therapy for non-metastatic patients. The discussion delved into neoadjuvant chemoradiation followed by surgery, adjuvant nivolumab consideration, and the evolving paradigm of perioperative chemotherapy.
The conversation also touched on the significance of MSI status and its impact on treatment decisions, particularly in the context of immunotherapy. Dr. Klempner emphasized the role of comprehensive NGS testing and the potential future implications of Claudin 18.2 and Zolbetuximab in the treatment landscape.
In the metastatic setting, the discussion revolved around HER2-targeted therapy, the addition of pembrolizumab, and the management of progressive disease. The potential use of TDXD as a second or third-line therapy was also explored, along with considerations for managing side effects, particularly interstitial lung disease.
Overall, the episode provided a comprehensive overview of the current treatment strategies and emerging trends in upper GI malignancies, offering valuable insights for oncologists navigating the complex landscape of gastrointestinal cancers.
