Gastroesophageal cancers Flashcards
T1a definition and treatment
Invading lamina propria/muscularis mucosae
Endoscopic resection
T1b definition and treatment
Invading submucosa
Esophagectomy/gastrectomy + LND
Treatment of high risk T2, T3+, or N+ esophageal SCC (2 options)
ChemoRT with weekly carbo/paclitaxel then surgery
Definitive chemoRT
High risk = +LVI, > 3cm, poorly differentiated
T4b definition and treatment for esophageal SCC
Invades adjacent structures such as aorta, vertebral body, or airway
Definitive chemoRT
Treatment of high risk T2, T3+, or N+ GEJ adenocarcinoma (2 options)
ChemoRT with weekly carbo/taxol or 5-FU + oxali -> surgery
FLOT x4 -> surgery -> FLOT x4
Treatment of T2+ or N+ gastric adenocarcinoma (2 options)
FLOT x4 -> surgery -> FLOT x4
Surgery -> capecitabine/oxaliplatin x 4-6 months
Can also use 5-FU + oxali instead of FLOT
Treatment of low risk T2 esophageal SCC
Surgery
Low risk = <3cm, well differentiated, no LVI
Treatment of localized unresectable gastric AC
ChemoRT with 5-FU + oxali/cisplatin
1st line metastatic esophageal SCC treatment
5-FU + oxali/cisplatin
If PD-L1 CPS >= 10 then add pembro
5-FU + irinotecan if recurrence within 6 months of platinum
2nd line and later metastatic esophageal SCC treatment
Nivo (regardless of PD-L1)
Paclitaxel
Irinotecan
Docetaxel
MSI-H/dMMR: pembro
1st line GEJ/gastric AC metastatic treatment
Her2-: 5-FU + oxali/cisplatin
Her2+: 5-FU + oxali/cisplatin + trastuzumab
PD-L1 CPS >= 5: 5-FU + oxali + nivo
2nd line GEJ/gastric AC metastatic treatment
MSI-H/dMMR: pembro
Her2+: trastuzumab deruxtecan
All others: paclitaxel +/- ramucirumab or FOLFIRI +/- ramucirumab
Ramucirumab for adeno only
3rd line GEJ/gastric AC metastatic treatment
Trifluridine/tipiracil (only AC)
PD-L1 CPS >= 1: pembro
