In the second panel of the Advancements in Oncology event, held on Saturday, June 1, The Oncology Brothers, Rahul Gosain, MD, MBA, and Rohit Gosain, MD, sat down with Cathy Eng, MD, FACP, FASCO, of Vanderbilt-Ingram Cancer Center, to discuss gastrointestinal (GI) cancer-related data from the 2024 American Society of Clinical Oncology Annual Meeting.
The trio pondered the evolving landscape of upper GI cancer treatments, particularly in the transition from localized to locally advanced stages, noting the potential impact of upcoming studies on treatment paradigms.
Comparing Chemoradiation Therapy, Perioperative FLOT Regimen
“One key study under scrutiny aims to compare the efficacy of chemoradiation therapy versus a perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) regimen,” Dr. Rohit Gosain explained. Dr. Eng highlighted the significance of this investigation, emphasizing the potential practice-altering implications. “The study’s design favors the superiority of FLOT over [chemoradiation followed by surgery (CROSS)], potentially reshaping treatment strategies if the data support this hypothesis,” she added.
The discussion extended to the implications of these findings on current treatment modalities. Notably, the availability of immunotherapy postsurgery in the CROSS regimen contrasts with the lack of evidence for its use alongside perioperative FLOT, posing challenges for clinical practice. Dr. Rahul Gosain emphasized the importance of observing these developments closely, hinting at the excitement surrounding the upcoming plenary session.
The conversation also touched upon the significance of investigator-initiated studies in driving innovation and challenging existing treatment norms. Dr. Eng underscored the potential for such studies to inspire junior investigators and foster persistence in exploring novel treatment avenues.
Progress in Advanced, Metastatic Settings
Shifting focus to advanced and metastatic settings, the conversation highlighted the ARMANI study’s investigation into maintenance therapy options following FOLFOX therapy. “The study examines the feasibility of switching to ramucirumab and docetaxel, potentially altering the landscape of second-line treatments,” Dr. Rohit Gosain explained.
Dr. Eng raised pertinent concerns regarding neuropathy and quality-of-life implications associated with these treatment shifts. While acknowledging the need to address oxaliplatin-related toxicity, uncertainties remain regarding the overall impact on patient outcomes and treatment efficacy.
Future Directions, Collaborative Efforts
As the field continues to evolve, the experts emphasized the importance of collaborative efforts and multidisciplinary approaches in navigating complex treatment decisions. Dr. Eng mentioned the ongoing TRANSMET study, which is exploring liver transplantation as a potential treatment avenue for patients with definitively unresectable colorectal liver metastases, underscoring the need for further research to validate these promising findings.
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