How do you approach choice of systemic chemotherapy for a young and otherwise healthy patient with HER2 negative esophogeal adenocarcinoma?

I really think that, in the US context, FOLFOX is the standard and preferred regimen. It is now the accepted regimen in US single-arm and randomized studies. Although there are differing toxicities, I would argue that cisplatin 60-80 mg/m2 (which is the dose in published regimens) represents cruel and unusual punishment compared to the mFOLFOX6 regimen. While esophagogastric cancer is uncommon, FOLFOX is used for almost every GI cancer and also adds another level of comfort for oncologists who don't frequently treat this cancer.

I think the use of any other regimen should be the exception rather than the rule. For example, in a Pt with significant baseline neuropathy, FOLFIRI is an acceptable alternative. If pushed, I sometimes give what is...