GI tumor treatment: Treatment Regimens

Question 1

What are the treatments for anal cancer?

Answer 1

Radiation alone (70% 5 yr survival)
Radiation + Cisplatin, 5-FU, Mitomycin (improved outcomes)

Question 2

What are the treatments for colorectal carcinoma?

Answer 2

5-FU + Leucovorin + oxaplatin (FOLFOX)
5-FU + Leucovorin + Irinotecan (FOLFIRI)

Capecitabine can be substituted for 5-FU

Brevicizumab
Cetruximab

Question 3

What are the treatments for esophageal cancer?

Answer 3

Stents
Radiation
Cisplatin + Flourouracil or
CDDP + 5-FU + vinbalstine

Taxanes are second line therapy

Question 4

What are the treatments for gastric cancer?

Answer 4

Trastuzumab (HER2 +)

5-FU + Cisplatin +/- Anthracycline + irinotecan/docetaxel

Glutamic acid (ancillary gastric acidifier)

Question 5

What is the treatment for GI Carcinoid tumors?

Answer 5

Octreotide (decreases serotonin, 12 months)
INF-Alpha ( Inhibits dz progression)

No protocol has response rate greater than 15%

Question 6

What are the adverse effects associated with IFN-alpha?

Answer 6

Alopecia
anorexia
Fatigue/weight loss/ fever
myelosuppression

Question 7

What are the treatments for GIST tumors?

Answer 7

Imatinib mesylate (inhibits BCR-ABL)
Sunitininb Malate (multi kinase inhibitor, VEGF, PDGF)(used in refractory cases)

Question 8

What are the treatments for Pancreatic cancer?

Answer 8

Pancreatic enzyme replacement

Gemcitabine or 5-FU/folinic acid
Gemcitabine and erlotinib(EGFR TKI) or
Leucovorin, flourouracil, irinotecan, oxiplatin, (FOLFIINOX)

Question 9

What are the treatments for Liver cancer?

Answer 9

Trans-catheter arterial embolization (TACE-doxorubicin)

Sorafenib (standard of care for advanced HCC)(Multikinase inhibitor, VEGF, PDGF)