Esophageal Cancer   

What would your approach be in a patient with a mid-esophageal squamous cell carcinoma treated with chemoradiation therapy followed by surgery, with P...

If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.

Is it necessary to test CPS given the FDA approvals are not contingent on CPS %?  If you do test, do you check 28-8 (nivolumab), 22C3 (pembroliz...

Are there meaningful differences in the CHECKMATE 649 and KEYNOTE 590 studies to guide this decision?

Do you go by FDA approval alone, or incorporate other data into your treatment decisions?  How do you view updated recent presentation of CM-649 ...

Do you view CPS < 1% or 1-4% separately? Do you view the incremental benefit of adding immunotherapy still advantageous given relatively poor outco...

Would you use reduced dose chemoimmunotherapy, single agent chemotherapy, or single agent immunotherapy if the patient is unlikely to tolerate full do...

Would you ever consider adjuvant chemotherapy rather than adjuvant immunotherapy after the publication of the CM-577 results? If so, in which pop...

NCCN recommends perioperative FLOT or FOLFOX vs. neoadjuvant chemoRT with Carboplatin/Paclitaxel or FOLFOX.Does CM-577 and the approval of nivolumab p...

What about for a patient with complete radiographic response who declines surgical management?

Based on CheckMate 577?Is DFS endpoint sufficient to establish SOC or is OS benefit needed?

What factors would influence your approach?

Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data...

CheckMate 577 only included patients with R0 resection.For R1 resections, guidelines suggest observation vs re-resection only.  

In the case of multiple skip lesions in the thoracic esophagus and GE junction, the PTV may encompass nearly the entire esophagus, including the supra...

In a patient who is not a surgical candidate, do you offer concurrent carbo/taxol rather than 5FU/oxaliplatin? 

What is the risk of perforation / fistulization?

If you would elect for adjuvant therapy, which study helps guide your choice of regimen?

The upfront plan is to use a definitive radiation dose of 66 Gy. My reading supports the use of 5FU + cisplatin but another doctor is recommending FOL...

Liver and skeletal metastasis with no disease in the lung.

What is the added benefit of Chemo-RT vs RT alone?

Preferred options in NCCN guidelines: 5FU+cisplatin, 5FU+oxaliplatin, paclitaxel+carboplatin?

Do you utilize it immediately following chemoRT or wait until disease progression?

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophagea...

What chemotherapy and radiation doses/fractionation would you use once the airway has been stabilized to provide reasonably safe and effective palliat...

If the patient has large, bulky nodes would you consider starting after chemotherapy for cytoreduction? Or otherwise consider replanning mid-treatment...

If so, what regimen would you consider?

What other molecular tests do you routinely order on such tumors?

I.e. Would you treat most of the normal esophagus to include a mediastinal lymph node? 

What regional lymph nodes do you include perigastric, portahepatic, periesophageal, celiac, splenic, pancreaticoduodenal, sup. mesenteric, paraesophag...

We use PET for esophageal, but not gastric cancer. GE junction seems like a grey area. 

Does the advent of FLOT in gastric cancers, change your approach to GE adeno's? Would anyone consider FLOT followed by chemoradition followed by surge...