The discussion covers several key topics in the management of esophageal and gastric cancers:
Adoption of the ESOPEC trial data: The oncologists agree that the FLOT (5-FU/leucovorin/oxaliplatin/docetaxel) regimen will likely become the preferred neoadjuvant approach over the CROSS (chemoradiation) regimen for patients with locally advanced esophageal adenocarcinoma. However, they note the need to carefully select patients who can tolerate the FLOT regimen.
Role of PD-L1 testing: PD-L1 testing is now routinely performed, as it guides decisions on incorporating immunotherapy. There is a trend towards a binary approach, where patients with any PD-L1 positivity may be considered for checkpoint inhibitors.
Emerging frontline trials: The oncologists are exploring novel triplet chemotherapy regimens, such as FOLFIRINOX, as potential alternatives to FLOT or FOLFOX in the frontline setting. These trials also incorporate targeted therapies and immunotherapy.
Second-line and beyond: For patients who progress after frontline therapy, the oncologists discuss the potential role of emerging targeted agents, such as antibody-drug conjugates (ADCs) and claudin-18.2 inhibitors, in addition to the standard ramucirumab plus paclitaxel.
Surgical considerations: The oncologists acknowledge that a subset of patients with oligometastatic disease may benefit from surgical resection, but emphasize the need for careful patient selection and a window of systemic therapy prior to considering surgery.
Overall, the discussion highlights the rapidly evolving landscape of esophageal and gastric cancer management, with a focus on personalized, biomarker-driven approaches and combination strategies to improve patient outcomes.
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by Samuel J. Kl... om www.medscape.com 09-26-2024
https://www.medscape.com/viewarticle/999886Diepere vragen