How do you select neoadjuvant chemo vs chemoRT in locally advanced, resectable GEJ/esophageal tumors?  

At a recent tumor board, we discussed the interim results of the Neo-AEGIS randomized trial presented at ASCO 2021. Briefly, this was a randomized trial of CROSS-regimen neoadjuvant chemoRT (41.4 Gy) versus perioperative chemotherapy alone (MAGIC or FLOT) for cT2-3 N0-3 M0 esophageal or GEJ adenocar...

For locally advanced, resectable distal esophageal and GE junction (Siewert I/II) adenocarcinomas, my standard recommendation is neoadjuvant chemoradiation with weekly carboplatin and paclitaxel based on the CROSS trial. FOLFOX is also a very reasonable chemotherapy partner for radiation. We don't h...

I think the question is asked because of the ASCO 2021 updates so I am not going to try to explain the "cross" trial comparisons including the CROSS trial. Why? Because CROSS had been the law of the land but not sure it bode well for it in this group.If CROSS is not better than MAGIC as in NeoAegis ...

There are geographical differences throughout the world with regards to whether medical oncologists prefer to use neoadjuvant chemoradiation or perioperative chemotherapy in GEJ tumors. At all of the institutions that I have worked at during my career, we have preferred to use neoadjuvant chemoRT fo...

Not at all. Ultimately, the choice of chemoradiation vs. chemotherapy for an esophageal/GEJ remains a contentious one. The results of the Neo-AEGIS study were recently presented (Reynolds, J Clinical Oncol 2021 [abstr]). While peri-operative chemotherapy was not shown to be inferior to pre-operative...

FLOT is well tolerated. The patients who do not tolerate the full dose, 10-15 dose reduction all is needed. I have been treating all comers for the past ten years with excellent outcomes and tolerable toxicities.

The upfront decision is still made as it always was, based on the location and biology of the cancer. I would still consider perioperative chemotherapy in patients with Siewert III GEJ cancers, particularly poorly differentiated and signet ring tumors, or in true gastric tumors. The availability of ...

In general, the way I think it through in MSS/pMMR gastric and GEJ adenocarcinoma, if I am more concerned regarding systemic relapse due to lymph node status or other prognostic variable and the patient is fit enough to receive FLOT then go ahead with FLOT. If the patient has a GEJ adenocarcinoma an...

Neoadjuvant chemo and targeted therapy, as local control is better with neoadjuvant treatment and then surgery.