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Gastrointestinal Cancers • Medical Oncology
How would you manage a patient with T4N1 duodenal adenocarcinoma by EUS with ampullary invasion that is dMMR?
Is there any data to support the use of immune checkpoint inhibitors either preoperatively or even definitively, similar to rectal or gastric?
Answer from: Medical Oncologist at Academic Institution
This is a practical question since Lynch syndrome patients do get upper GI (including duodenal) polyps and cancers. Vos et al., JCO 2021 39.3_suppl.244 The standard of care here would be to do surgery at some point, so any deviation from that would need to be discussed carefully with the patient and...
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Answer from: Medical Oncologist at Academic Institution
Our current trial of Neoadjuvant Pembro for resectable gastric (MMRD, and PDL1+) cancer shows this is feasible and 50% downstaging with 2 doses preop (Kennedy et al. Journal of Clinical Oncology 2023, e16073). For MSI-H, 2 of 3 patients had pCR after 2 doses. I would feel comfortable treating with n...