In these two podcast episodes, GI oncologists discuss the clinical cases of two patients with gastric and gastroesophageal (GE) cancer.

Episode 1 focuses on a patient with non-metastatic cancer, while Episode 2 looks at a metastatic case.

Listen to both podcast episodes or watch a video recording of the conversation for an update on:

  • Treatment sequences in gastric and gastroesophageal cancer
  • Practice-changing data and essential biomarker testing 
  • Near-future developments in the field

 

 

Clinical Takeaways

  • It is crucial to test all localised or locally advanced gastric and GE junction cancers for mismatch repair status. Patients with operable MMR-deficient tumours have intrinsically better prognoses, limited if any benefit from perioperative chemotherapy alone, and are more likely to benefit from neoadjuvant/perioperative immunotherapy. Deficient MMR/MSI-high GE patients should be discussed in multi-disciplinary conference given the impact on management decisions.

  • Patients with operable GE junction cancers are candidates for perioperative FLOT and/or neoadjuvant chemoradiation approaches. These approaches have not been compared directly, however, perioperative chemotherapy may be more appropriate for patients with clinically involved lymph nodes who are at high risk of systemic relapse. Perioperative immunotherapy is not standard although phase III trials are expected soon.

  • In advanced gastric cancer, biomarker testing at diagnosis is required to guide treatment decisions. The most critical biomarkers include MMR, HER2, and PD-L1.

  • Fit patients with operable GE junction cancer and lymph node involvement often receive standard FLOT chemotherapy. Neo-adjuvant immunotherapy is promising in MMR-deficient patients

  • The treatment landscape for gastric cancer is evolving. One notable upcoming treatment is zolbetuximab. Future treatment decisions may involve a careful evaluation of biomarker status, such as CLDN18.2 and PD-L1, to determine the most suitable therapy. In future, sequential treatment strategies involving multiple targeted therapies may offer improved outcomes, and repeat biopsies could be essential to assess for resistance mechanisms and adjust treatment accordingly.

Dr Samuel J. Klempner is a GI medical oncologist with research and clinical focus on esophagogastric cancers and cancer genomics. Dr Klempner completed his residency in internal medicine at Brigham and Women’s Hospital/Harvard Medical School, followed by a combined hematology-oncology fellowship at Beth Israel Deaconess Medical Center/Harvard Medical School. While at Harvard, Dr Klempner studied the mechanisms of resistance to targeted therapies in tumor cells in the lab of Dr Lewis Cantley, PhD. Dr Klempner is board certified in medical oncology, hematology, and internal medicine. Prior to joining The Angeles Clinic and Research Institute Dr Klempner served as an Assistant Clinical Professor in the division of Hematology-Oncology at the University of California Irvine. Dr Klempner’s research interests include the intersection of genomics and immunotherapies, oncogene-driven tumors, acquired resistance, and experimental therapeutics. Dr Klempner is involved in professional societies including the American Society of Clinical Oncology (ASCO), American Association for Cancer Research (AACR), and the European Society for Medical Oncology (ESMO).

Dr Samuel J Klempner has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Astellas, AstraZeneca, BMS, Coherus, Daiichi-Sankyo, Eli Lilly, Merck, Novartis, Nuvalent Therapuetics and Sanofi.

Elizabeth (Lizzy) Smyth is a consultant in gastrointestinal oncology. Dr Smyth commenced her oncology training in Dublin, Ireland. In 2009 she was awarded a fellowship from the Irish Society of Medical Oncology to train at Memorial Sloan-Kettering Centre, New York. Following this, she worked at the Royal Marsden Hospital in London from 2011-2018. Her research focus is on clinical trials and translational research in gastroesophageal cancer, and she has worked on trial design and management of national and international trials. She is a member of the European Society for Medical Oncology GI Faculty and leads the EORTC GI Trials Group Gastric Cancer Taskforce. Dr Smyth is committed to furthering national and international collaboration in GI trials research.

Dr Elizabeth Smyth has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Personal financial interests (lecture honoraria, advisory boards, travel support): Amal Therapeutics, Aptitude Health, Amgen, Astellas, AstraZeneca, Beigene, BMS, Celgene, Daiichi Sankyo, Elsevier, Everest Clinical Research, First Word Group, Five Prime Therapeutics, Gritstone Oncology, Imedex, Merck, My Personal Therapeutics, Novartis, Pfizer, Roche, Sai-Med, Servier, Touch Oncology, Turning Point Therapeutics, Zymeworks

Institutional funding for research: Amgen, Astellas, Astra Zeneca, Basilea, BMS, Daiichi Sankyo, MSD, Macrogenics, Merus, Novartis, Roche, Seagen

Programme summary
  • clock Duration 43 MIN
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Other episodes in this series
Gastroesophageal Cancer: Clinical Case Discussions

Gastroesophageal Cancer: Clinical Case Discussions

Episode 1: Non-metastatic cancer patient case

Gastroesophageal Cancer: Clinical Case Discussions

Gastroesophageal Cancer: Clinical Case Discussions

Episode 2: Metastatic cancer patient case

Gastroesophageal Cancer: Clinical Case Discussions

Gastroesophageal Cancer: Clinical Case Discussions

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