Staging Superstars
These imaging/procedures are involved in gastric cancer/GEJ staging.
CT C/A/P oral and IV contrast
PET scan - detects distant mets in 10% missed by CT
EGD/EUS (depth)
Laparoscopy with cytology to evaluate for peritoneal spread if T1B higher
Bronchoscopy if tumor is at or above the carina, to rule out posterior trachea invasion
FLOT4 study showed that this regimen was better than ECF (previous standard)
What are 5-FU, leucovorin, oxaliplatin and docetaxel?
if a patient with adenocarcinoma is HER2 positive this regimen is supported by the TOGA trial
What is FOLFOX + traztuzumab (or 5FU/cisplatin)
Add Pembro if CPS > 1 (KEYNOTE 811)
T/F There is no data to suggest preoperative vs postoperative chemotherapy is better in local gastric/GEJ cancers
What is true?
One should test for these 4 markers in metastatic disease.
What is HER2, PDL-1, MMR, and CLDN 18.2?
In adenocarcinoma, FLOT is considered to be superior to chemoRT based on which trial
What is ESOPEC?
These are first line options for metastatic squamous cell carcinoma
What is Pembro + FOLFOX, Nivo + folfox, Ipi/nivo?
These are considered regional and non regional lymph nodes
Regional node = mediastinal or celiac node
Distant node - nonregional (hilar or distal to celiac axis).
Whether positive supraclavicular node is advanced vs locally advanced is debatable
This stage require can get endomucosal resection
What is stage T1A (lamina propria/musclaris mucosa)?
The MATTERHORN study showed that addition of this to FLOT improved EFS and pathologic complete response rates
What is durvalumab?
The SPOTLIGHT and GLOW studies show a benefit of this medication in metastatic adenocarcinoma patients with CLDN 18.2.
What is zolbetuximab?
Side effect is nausea --> needs triple prophylaxis!
T/F Cisplatin is equivalent to oxaliplatin in metastatic setting (when added to 5-FU)
What is true per RATIONALE?
What is Stage T1B (invading into submucosa?
For locally advanced squamous cell esophageal cancer , this regimen is preferred.
What is the CROSS Regimen?
CXRT (carbo/paclitaxel)
These immunotherapies are approved for metastatic adenocarcinoma.
What are pembrolizumab CPS > 1, atezolizumab CPS > 5, Pembro CPS > 1, and nivolumab CPS > 5?
Add this to FOLFOX backbone
If a patient with gastric adenocarcinoma did not receive preoperative therapy and underwent a D1 resection, they should receive this regimen per MCDONALD trial?
What is 5-FU x 1 cycle then 5-FU with RT, then 5-FU x 2 cycles?
Better tolerated regimen 5-FU 400mg/m2 bolus + 5FU 2400mg/m2 for 46 hours q14 days and capecitabine during radiation segment
Invasion into this layer requires chemo +/- radiation?
What is muscularis propria (T2)?
Also N+
If a patient received chemoRT prior to surgery and has residual disease (adeno or squamous), this can be added per CHECKMATE 577.
What is adjuvant nivolumab?
These are refractory regimens for adenocarcinoma
Ramicirumab/paclitaxel (RAINBOW trial)
T-DXD if HER2
FOLFIRI +/- ram
3rd line - lonsurf
If a patient with gastric adenocarcinoma did not receive preoperative therapy and underwent a D2 resection, they should receive this regimen per CLASSIC trial?
What is adjuvant capecitabine?