Immunotherapy in Gastroesophageal Cancer: Is It One Size Fits All or Only If the CPS Fits?

In the current oncological practice surgical treatment of gastroesophageal cancer with high involvement of the esophagus can extend to total esophago-gastrectomy with colonic interposition as the main method of radical treatment. However the technical complexity and high risk of the intervention are factors in determining the divergent views on the operation itself, testimony for the criteria of patient’s selection, choice of surgical access and the formation of a colonic graft in conjunction with method of esophageal reconstruction. The long-term results of operative intervention depend primarily on the extent of tumor process but obviously higher than after conservative treatment. This article presents a brief critical overview of the main aspects of the simultaneous application of esophago-gastrectomy in surgery of gastroesophageal cancer with high esophageal involvement and our clinical case of successful surgical treatment of a woman with pregnancy-associated gastroesophageal cancer.

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Optimising Chemotherapy for Frail and Older Patients With Advanced Gastroesophageal Cancer: The GO2 Phase III Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3724274 ◽

2020 ◽

Author(s):

Peter Hall ◽

Daniel Swinson ◽

David A. Cairns ◽

Justin Waters ◽

Russell Petty ◽

...

Keyword(s):

Older Patients ◽

Phase Iii ◽

Gastroesophageal Cancer ◽

Phase Iii Trial

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Gender Differences in Treatment Allocation and Survival of Advanced Gastroesophageal Cancer: a Population-Based Study

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab075 ◽

2021 ◽

Author(s):

Willemieke P M Dijksterhuis ◽

Marianne C Kalff ◽

Anna D Wagner ◽

Rob H A Verhoeven ◽

Valery E P P Lemmens ◽

...

Keyword(s):

Gender Differences ◽

Systemic Treatment ◽

Statistical Tests ◽

Tumor Biology ◽

Rank Test ◽

Lower Probability ◽

Gastroesophageal Cancer ◽

Treatment Allocation ◽

Netherlands Cancer Registry ◽

Treatment Administration

Abstract Background Biological sex and gender have been reported to impact incidence and overall survival (OS) of curatively treated gastroesophageal cancer. The aim of this study was to compare palliative treatment allocation and OS between women and men with advanced gastroesophageal cancer. Methods Patients with an unresectable (cT4b) or metastatic (cM1) esophageal (including cardia) adenocarcinoma (EAC) or squamous cell carcinoma (ESCC), or gastric adenocarcinoma (GAC) diagnosed in 2015-2018 were identified in the Netherlands Cancer Registry. Treatment allocation was compared using chi-squared tests and multivariable logistic regression analyses, and OS using the Kaplan-Meier method with log-rank test and Cox proportional hazard analysis. All statistical tests were 2-sided. Results Of patients with EAC (n = 3,077), ESCC (n = 794) and GAC (n = 1,836), 18.0%, 39.4% and 39.1% were women, respectively. Women received less often systemic treatment compared to men in EAC (42.7% vs. 47.4%, P = 0.045) and GAC (33.8% vs. 38.8%, P = 0.03), but not in ESCC (33.2% vs. 39.5%, P = 0.07). Women had a lower probability of receiving systemic treatment in GAC in multivariable analyses (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.62-1.00), but not in EAC (OR = 0.86, 95%CI = 0.69-1.06) and ESCC (OR = 0.81, 95%CI = 0.57-1.14). Median OS was lower in women with EAC (4.4 vs. 5.2 months, P = 0.04), but did not differ after adjustment for patient and tumor characteristics and systemic treatment administration. Conclusion We observed statistically significant and clinically relevant gender differences in systemic treatment administration and OS in advanced gastroesophageal cancer. Causes of these disparities may be sex-based, i.e. related to tumor biology, as well as gender-based, e.g. related to differences in treatment choices.

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Immunotherapy Predictive Molecular Markers in Advanced Gastroesophageal Cancer: MSI and Beyond

Cancers ◽

10.3390/cancers13071715 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1715

Author(s):

Robin Park ◽

Laercio Lopes ◽

Anwaar Saeed

Keyword(s):

Treatment Options ◽

Unmet Need ◽

Predictive Biomarkers ◽

Phase Iii ◽

Gastroesophageal Cancer ◽

Programmed Death ◽

Phase Iii Trials ◽

Tumor Mutational Burden ◽

Large Phase ◽

Programmed Death 1

Advanced gastroesophageal cancer (GEC) has a poor prognosis and limited treatment options. Immunotherapy including the anti-programmed death-1 (PD-1) antibodies pembrolizumab and nivolumab have been approved for use in various treatment settings in GEC. Additionally, frontline chemoimmunotherapy regimens have recently demonstrated promising efficacy in large phase III trials and have the potential to be added to the therapeutic armamentarium in the near future. There are currently several immunotherapy biomarkers that are validated for use in the clinical setting for GEC including programmed death ligand-1 (PD-L1) expression as well as the tumor agnostic biomarkers such as mismatch repair or microsatellite instability (MMR/MSI) and tumor mutational burden (TMB). However, apart from MMR/MSI, these biomarkers are imperfect because none are highly sensitive nor specific. Therefore, there is an unmet need for immunotherapy biomarker development. To this end, several biomarkers are currently being evaluated in ongoing trials with some showing promising predictive potential. Here, we summarize the landscape of immunotherapy predictive biomarkers that are currently being evaluated in GEC.

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Influence of Baseline Positron Emission Tomography in Metastatic Gastroesophageal Cancer on Survival and Response to Therapy

Oncology ◽

10.1159/000517842 ◽

2021 ◽

pp. 1-6

Author(s):

Ahmed Abdelhakeem ◽

Madhavi Patnana ◽

Xuemei Wang ◽

Jane E. Rogers ◽

Mariela Blum Murphy ◽

...

Keyword(s):

Positron Emission Tomography ◽

Response To Therapy ◽

Emission Tomography ◽

Gastroesophageal Cancer ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Positron Emission ◽

Pet Ct ◽

Metastatic Burden

Background: The value of baseline fluorodeoxyglucose-positron emission tomography-computed tomography (PET-CT) remains uncertain once gastroesophageal cancer is metastatic. We hypothesized that assessment of detailed PET-CT parameters (maximum standardized uptake value [SUVmax] and/or total lesion glycolysis [TLG]), and the extent of metastatic burden could aid prediction of probability of response or prognosticate. Methods: We retrospectively analyzed treatment-naive patients with stage 4 gastroesophageal cancer (December 2002–August 2017) who had initial PET-CT for cancer staging at MD Anderson Cancer Center. SUVmax and TLG were compared with treatment outcomes for the full cohort and subgroups based on metastatic burden (≤2 or >2 metastatic sites). Results: We identified 129 patients with metastatic gastroesophageal cancer who underwent PET-CT before first-line therapy. The median follow-up time was 61 months. The median overall survival (OS) was 18.5 months; the first progression-free survival (PFS) was 5.5 months. SUVmax or TLG of the primary tumor or of all metastases combined had no influence on OS or PFS, whether the number of metastases was ≤2 or >2. Overall response rates (ORRs) to first-line therapy were 48% and 45% for patients with ≤2 and >2 metastases, respectively (nonsignificant). ORR did not differ based on low or high values of SUVmax or TLG. Conclusions: This is the first assessment of a unique set of PET-CT data and its association with outcomes in metastatic gastroesophageal cancer. In our large cohort of patients, detailed analyses of PET-CT (by SUVmax and/or TLG) did not discriminate any parameters examined. Thus, baseline PET-CT in untreated metastatic gastroesophageal cancer patients has limited or no utility.

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Unique Considerations in Preventing Intraoperative Aspiration in a Patient with Gastroesophageal Cancer

Journal of the National Medical Association ◽

10.1016/j.jnma.2020.09.018 ◽

2020 ◽

Vol 112 (5) ◽

pp. S9-S10

Author(s):

Andrew Ta ◽

Nicole C.P. Thompson

Keyword(s):

Gastroesophageal Cancer

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Adjuvant Chemoradiotherapy May be Warranted for Locally Advanced Gastric or Gastroesophageal Cancer Patients Even Though They Received Curative Gastrectomy (>D1)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.775 ◽

2010 ◽

Vol 78 (3) ◽

pp. S326-S327

Author(s):

X. Wang ◽

J. Jin ◽

Y.X. Li ◽

S.L. Wang ◽

W.H. Wang ◽

...

Keyword(s):

Cancer Patients ◽

Locally Advanced ◽

Adjuvant Chemoradiotherapy ◽

Gastroesophageal Cancer ◽

Curative Gastrectomy

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Thromboembolism in Patients With Advanced Gastroesophageal Cancer Treated With Anthracycline, Platinum, and Fluoropyrimidine Combination Chemotherapy: A Report From the UK National Cancer Research Institute Upper Gastrointestinal Clinical Studies Group

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.4274 ◽

2009 ◽

Vol 27 (23) ◽

pp. 3786-3793 ◽

Cited By ~ 122

Author(s):

Naureen Starling ◽

Sheela Rao ◽

David Cunningham ◽

Timothy Iveson ◽

Marianne Nicolson ◽

...

Keyword(s):

Combination Chemotherapy ◽

Treated Patient ◽

Controlled Trial ◽

Central Venous Access ◽

Locally Advanced ◽

Venous Access ◽

Gastroesophageal Cancer ◽

National Cancer Research Institute ◽

The Uk ◽

Venous Access Device

PurposeData concerning the prevalence of and outcomes related to thromboembolic events (TEs) in patients with advanced gastroesophageal cancer who are undergoing chemotherapy are limited.Patients and MethodsThis was a prospective, exploratory analysis of TEs in a randomized, controlled trial of 964 patients recruited between 2000 and 2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy for advanced/locally advanced gastroesophageal cancer. Regimens were epirubicin (E), cisplatin (C), fluorouracil (F; ECF); E, C, capecitabine (X; ECX); E, F, oxaliplatin (O; EOF); and EOX. Continuously infused F was administered via a central venous access device (CVAD) with 1 mg of warfarin for thromboprophylaxis. The principal outcome was the incidence of TEs (venous and arterial) in the whole treated patient cohort, according to chemotherapy, associated with CVADs and TE-related prognoses.ResultsThe incidences of any, of venous, and of arterial TEs among 964 treated patients were 12.1% (95% CI, 10.7 to 14.3), 10.1% (95% CI, 8.3 to 12.3), and 2.2% (95% CI, 1.4 to 3.4) respectively. There were fewer TEs in the O compared with the cisplatin groups (EOF/EOX v ECF/ECX: 7.6% v 15.1%; P = .0003). C was identified as a risk factor for TE in multivariate analysis (hazard ratio [HR], 0.51; 95% CI, 0.34 to 0.76; P = .001). There was no difference in the incidence of TEs for the F group compared with the capecitabine groups. The incidence of CVAD-related thrombosis was 7.0% (ECF/EOF arms). Overall survival was worse for patients who experienced TEs versus no TEs (median survival, 7.4 v 10.5 months; HR, 0.8; 95% CI, 0.64 to 0.99; P = .043).ConclusionThis analysis has prospectively quantified the incidence/pattern of TEs among patients with advanced gastroesophageal cancer who were treated with four triplet regimens, has demonstrated a differential thrombogenic effect according to platinum use, and has noted a poorer outcome associated with TE during treatment. Chemotherapy-related TE should contribute to the risk/benefit assessment of treatment.

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