What first line regimen for metastatic esophageal or GEJ adenocarcinoma would you use in an elderly patient (>80) with medical comorbidities?
Would you use reduced dose chemoimmunotherapy, single agent chemotherapy, or single agent immunotherapy if the patient is unlikely to tolerate full dose chemoimmunotherapy? What CPS cutoff would you use for single agent immunotherapy?
Answer from: Medical Oncologist at Academic Institution
Totally agree with Dr. @Craig R. Hildreth's recommendation, may consider to add Nivolumab to the dose reduced CAPOX or FOLFOX if the PD-L1 CPS>=5 based on the Checkmate 649 study result.
Answer from: Medical Oncologist at Academic Institution
This is always a tough question. At least in colon cancer, there is evidence that an elderly patient with co-morbidities would not benefit from the addition of oxaliplatin to fluorouracil infusion. However, the disease burden for lower tract cancers tends to be less than for upper tract disease. For...
Answer from: Medical Oncologist at Academic Institution
For an elderly patient with medical comorbidities but still adequate performance status, I believe doublet chemotherapy with a regimen such as FOLFOX can still be considered. I may utilize an upfront 20% or even 40% dose reduction in which the recent GO2 phase 3 randomized trial appears to validate ...
This was most informative. Thank you for posting t...