How do you select neoadjuvant chemo vs chemoRT in locally advanced, resectable GEJ/esophageal tumors?
NCCN recommends perioperative FLOT or FOLFOX vs. neoadjuvant chemoRT with Carboplatin/Paclitaxel or FOLFOX.
Does CM-577 and the approval of nivolumab post-chemoRT affect your up front treatment decisions?
Answer from: Radiation Oncologist at Academic Institution
At a recent tumor board, we discussed the interim results of the Neo-AEGIS randomized trial presented at ASCO 2021. Briefly, this was a randomized trial of CROSS-regimen neoadjuvant chemoRT (41.4 Gy) versus perioperative chemotherapy alone (MAGIC or FLOT) for cT2-3 N0-3 M0 esophageal or GEJ adenocar...
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Medical Oncologist at Locum Tenens Nice discussion. Thank you!
Radiation Oncologist at Beaumont Health System Thank you for the discussion.
I find it interesti...
Radiation Oncologist at Beaumont Health System 100% Dr. @Ronald Levitin.
Medical Oncologist at Charles A. Sammons Cancer Center at Baylor University Medical Center @Ronald Levitin
Thank you for the excellent comme...
Answer from: Medical Oncologist at Academic Institution
For locally advanced, resectable distal esophageal and GE junction (Siewert I/II) adenocarcinomas, my standard recommendation is neoadjuvant chemoradiation with weekly carboplatin and paclitaxel based on the CROSS trial. FOLFOX is also a very reasonable chemotherapy partner for radiation. We don't h...
Answer from: Medical Oncologist at Academic Institution
I think the question is asked because of the ASCO 2021 updates so I am not going to try to explain the "cross" trial comparisons including the CROSS trial. Why? Because CROSS had been the law of the land but not sure it bode well for it in this group.If CROSS is not better than MAGIC as in NeoAegis ...
Answer from: Medical Oncologist at Academic Institution
There are geographical differences throughout the world with regards to whether medical oncologists prefer to use neoadjuvant chemoradiation or perioperative chemotherapy in GEJ tumors. At all of the institutions that I have worked at during my career, we have preferred to use neoadjuvant chemoRT fo...
Answer from: Medical Oncologist at Academic Institution
Not at all. Ultimately, the choice of chemoradiation vs. chemotherapy for an esophageal/GEJ remains a contentious one. The results of the Neo-AEGIS study were recently presented (Reynolds, J Clinical Oncol 2021 [abstr]). While peri-operative chemotherapy was not shown to be inferior to pre-operative...
Answer from: Medical Oncologist at Academic Institution
FLOT is well tolerated. The patients who do not tolerate the full dose, 10-15 dose reduction all is needed. I have been treating all comers for the past ten years with excellent outcomes and tolerable toxicities.
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Medical Oncologist at St Louis Cancer Care LLP Not only that, but FLOT sometimes provides long-te...
Answer from: Medical Oncologist at Academic Institution
The upfront decision is still made as it always was, based on the location and biology of the cancer. I would still consider perioperative chemotherapy in patients with Siewert III GEJ cancers, particularly poorly differentiated and signet ring tumors, or in true gastric tumors. The availability of ...
Answer from: Medical Oncologist at Academic Institution
In general, the way I think it through in MSS/pMMR gastric and GEJ adenocarcinoma, if I am more concerned regarding systemic relapse due to lymph node status or other prognostic variable and the patient is fit enough to receive FLOT then go ahead with FLOT. If the patient has a GEJ adenocarcinoma an...
Nice discussion. Thank you!
Thank you for the discussion. I find it interesti...
100% Dr. @Ronald Levitin.
@Ronald Levitin Thank you for the excellent comme...