Podcasts about gastroesophageal

Is your gastroesophageal adenocarcinoma (GEA) treatment plan ready for the latest human epidermal growth factor receptor 2 (HER2) innovations? Credit available for this activity expires: 05/29/2027 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/ready-launch-gastroesophageal-adenocarcinoma-anti-her2-2026a1000gtw?ecd=bdc_podcast_libsyn_mscpedu

Featuring proceedings from a live event on January 9, 2026, held adjunct to the 2026 ASCO Gastrointestinal Cancers Symposium and moderated by Dr Samuel J Klempner, including the following topics: Treatment approach for metastatic HER2-negative, claudin 18.2-positive, microsatellite instability-high gastroesophageal (GE) cancer (0:00) Duration of chemotherapy for patients with advanced GE cancers receiving nivolumab/chemotherapy (3:06) Younger patient with metastatic PD-L1-positive gastric cancer (5:29) CME information and select publications

Featuring perspectives from Dr Jaffer A Ajani, Dr Samuel J Klempner, Dr Rutika Mehta and Dr John Strickler, moderated by Dr Klempner, including the following topics: Role of PD-L1 status, tumor histology and pulmonary disease in selection of immune checkpoint inhibition as up-front therapy (0:00) Impact of metastatic site and autoimmune disease on clinical decision-making in the use of immune checkpoint inhibition (5:56) Biomarker assessment approach and treatment selection (10:50) CME information and select publications

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Samuel Klempner from Massachusetts General Hospital in Boston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, and Dr John Strickler from Duke University in Durham, North Carolina, review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium. CME information and select publications here.

In this podcast episode, Amit Mahipal, MD, MPH, and Shubham Pant, MD, discuss new and emerging therapies for the individualized care of patients with HER2-positive gastroesophageal adenocarcinoma and biliary tract cancer, including: A brief overview of BTC and GEA Notable findings from a recent survey of healthcare professionals on BTC and GEA Case studies on recommended management of patients with BTC or GEA Emerging datasets of HER2-directed therapies in BTC and GEA affecting clinical practice Challenges faced by healthcare professionals in the management of patients with BTC and/or GEA Key ongoing trials of HER2-directed therapies in BTC and GEA Presenters:  Amit Mahipal, MD, MPH Chief, GI Medical Oncology Program Professor of Medicine Ruth and Goodman Endowed Chair in GI Oncology H Seidman Cancer Center and Case Western Reserve University Cleveland, Ohio Shubham Pant, MD Professor Department of Gastrointestinal Medical Oncology Department of Investigational Cancer Therapeutics, Division of Cancer Medicine MD Anderson Cancer Center Houston, Texas Link to full program:https://bit.ly/4ckcBrZ Get access to all of our new podcasts by subscribing to the Decera Clinical Education Oncology Podcast on Apple Podcasts, YouTube Music, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Featuring perspectives from Dr Haley Ellis, Prof Eric Van Cutsem and Dr Zev Wainberg, moderated by Dr Lionel A Kankeu Fonkoua, including the following topics: Gastroesophageal cancer (0:00) Recurrent colorectal cancer (5:43) Colorectal cancer with brain metastases (9:59) CME information and select publications

Featuring perspectives from Dr Jaffer A Ajani, Dr Samuel J Klempner, Dr Rutika Mehta and Dr John Strickler, moderated by Dr Klempner, including the following topics: Older patient with metastatic claudin 18.2-positive gastroesophageal (GE) cancer (0:00) Management of nausea and vomiting with zolbetuximab for GE cancer (9:37) Younger patient with metastatic claudin 18.2-positive, PD-L1-positive GE cancer (15:34) CME information and select publications

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Samuel Klempner from Massachusetts General Hospital in Boston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, and Dr John Strickler from Duke University in Durham, North Carolina, review relevant data supporting immunotherapy for patients with gastroesophageal cancers and recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Are you familiar with the most common treatment-related events of emerging HER2-targeted therapies for gastroesophageal adenocarcinoma (GEA)? Credit available for this activity expires: 3/30/27 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/nurse-view-evolution-anti-her2-therapies-gastroesophageal-2026a100096j?ecd=bdc_podcast_libsyn_mscpedu

Featuring perspectives from Dr Jaffer A Ajani, Dr Samuel J Klempner, Dr Rutika Mehta and Dr John Strickler, moderated by Dr Klempner, including the following topics: Younger patient with metastatic HER2-positive, PD-L1-positive gastric cancer (0:00) Older patient with metastatic HER2-positive gastroesophageal (GE) cancer (8:13) Clinical applications for zanidatamab in GE cancer (13:58) CME information and select publications

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, Dr John Strickler from Duke University in Durham, North Carolina, and moderator Dr Samuel Klempner from Massachusetts General Hospital in Boston review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, Dr John Strickler from Duke University in Durham, North Carolina, and moderator Dr Samuel Klempner from Massachusetts General Hospital in Boston review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, Dr John Strickler from Duke University in Durham, North Carolina, and moderator Dr Samuel Klempner from Massachusetts General Hospital in Boston review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Featuring perspectives from Dr Haley Ellis, Prof Eric Van Cutsem and Dr Zev Wainberg, moderated by Dr Lionel A Kankeu Fonkoua, including the following topics: Novel immune checkpoint inhibitors (0:00) Gastroesophageal junction cancer (7:36) Gastric cancer (14:52) CME information and select publications

Do you know how many different types of anti-HER2 therapies are in clinical trials for gastroesophageal adenocarcinoma (GEA)? Credit available for this activity expires: 02/27/2027 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/breaking-ground-gastroesophageal-adenocarcinoma-first-line-2026a10005tj?ecd=bdc_podcast_libsyn_mscpedu

Dr. Lakshmi Rajdev and Dr. Manish Shah join the podcast to discuss the updated guideline on immunotherapy and targeted therapy in unresectable locally advanced, advanced, or metastatic gastroesophageal cancer. They share first-line and subsequent-line recommendations for both gastroesophageal adenocarcinoma and esophageal squamous cell carcinoma based on actionable biomarkers including PD-L1 expression, MMR and/or MSI, CLDN18.2 expression, and HER2 status. They note the importance of the algorithms and tables in the guidelines that provide visual illustrations and quick reference guides of the evidence-based recommendations. They also comment on ongoing and recently presented trials that may impact future guidelines in this space. Read the full guideline, "Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update" at www.asco.org/gastrointestinal-cancer-guidelines" TRANSCRIPT This guideline, clinical tools and resources are available at www.asco.org/gastrointestinal-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  https://ascopubs.org/doi/10.1200/JCO-25-02958      Timestamps ·       00:00 – 02:15 Introduction and Overview ·       02:16 - 08:20 First-line treatment for patients with pMMR/MSS, HER2-negative gastroesophageal adenocarcinoma ·       08:21 –10:29 First-line treatment for patients with pMMR/MSS, HER2-positive gastroesophageal adenocarcinoma ·       10:30 – 14:39 First-line treatment for patients with dMMR/MSI-H, gastroesophageal adenocarcinoma ·       14:40 – 18:03 First-line treatment for ESCC ·       18:04 – 22:04 Second- and third-line therapy for gastroesophageal adenocarcinoma and ESCC ·       22:05 – 24:38 Importance of guideline ·       24:39 – 27:45 Outstanding questions and future research   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.   My name is Brittany Harvey, and today I am interviewing Dr. Lakshmi Rajdev from the Icahn School of Medicine at Mount Sinai and Dr. Manish Shah from Weill Cornell Medicine, co-chairs on "Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update." Thank you for being here today, Dr. Rajdev and Dr. Shah. Dr. Lakshmi Rajdev: Thank you. Dr. Manish Shah: Thank you for having us. It is wonderful. Brittany Harvey: And then just before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Rajdev and Dr. Shah, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into what we are here today to talk about, Dr. Shah, I would like to start first with what prompted the update to this guideline, which was previously published in 2023, and what is the scope of this updated guideline? Dr. Manish Shah: Yes, terrific. So even in the last few years, the pace of drug development in gastroesophageal cancers has just been astounding. So, what prompted this guideline is actually the practice-changing results for a new biomarker, CLDN18.2 hat was based on the GLOW and SPOTLIGHT studies, as well as a practice-changing study in HER2-positive disease where we added pembrolizumab to trastuzumab and chemotherapy for tumors that are HER2-positive and PD-L1 CPS 1 or greater. And then there were also new studies and new approvals in esophageal squamous cell cancer that you will hear about as well. So there were several studies, overall more than 5,000 patients were reported on, and that led to several new therapies, new indications, and it really necessitated this guideline. Brittany Harvey: Excellent. It is great to hear about all of these exciting updates in this space. So then to next review the key recommendations of this guideline by clinical question that the expert panel addressed. So, Dr. Rajdev, what is the recommended first-line treatment for patients with proficient mismatch repair, microsatellite stable, HER2-negative gastroesophageal adenocarcinoma? Dr. Lakshmi Rajdev: Thank you for that question. So historically, we have sort of used fluoropyrimidine and platinum doublets, which yielded a survival of about one year. More recently, immunotherapy and targeted therapy options have improved outcomes in patients with advanced esophageal and gastric adenocarcinoma, as well as squamous cell carcinoma. Patients with gastric and GE junction adenocarcinoma have a high rate of actionable alterations, so it is imperative that physicians test the following biomarkers upfront so that it can help guide therapy. The markers recommended by the ASCO panel are HER2, MMR or MSI, CLDN18.2, and PD-L1. And also, it was recommended to use NGS if feasible in this patient population. HER2, as we know, is expressed in about 15% to 25% of patients; PD-L1 expression occurs in about 80% of patients; MSI-high, deficient MMR is present in about 5% to 8% of patients; and CLDN18.2 expression is present in about 40% of patients. There is, of course, biomarker overlap. About 13% to 22% of CLDN18.2 patients are also PD-L1 positive. For patients with pMMR or microsatellite stable HER2-negative disease with PD-L1 expression greater than 1 and absence of CLDN18.2, the panel recommended a first-line therapy with fluoropyrimidine and platinum-based therapy in combination with immunotherapy. These recommendations stem from large phase 3 trials, and the agents approved in the United States are pembrolizumab, nivolumab, and tislelizumab. It has been shown that immunotherapy benefit is greater in patients with higher PD-L1 expression, and it is not possible to comment on the individual PD-L1 cutoff scores and sort of identify the optimal PD-L1 cutoff score that sort of balances benefits and harms. But what is recommended is that immunotherapy-based treatments can be offered in patients with a CPS score of greater than 1. With regard to the choice of immunotherapy agents, that is pembrolizumab, nivolumab, or tislelizumab, these agents are considered to have similar efficacy, and the selection of an agent could be based on dosing schedule, cost considerations, toxicity, and the method of administration. Typically, clinicians should avoid withholding the start of chemotherapy while awaiting biomarker testing, depending on the clinical scenario. Now, for patients with pMMR microsatellite stable disease that is HER2-negative with PD-L1 expression less than 1 and positive CLDN18.2 expression, zolbetuximab-based treatments or in combination with chemotherapy is recommended, and this is based on two global phase III randomized controlled trials, the GLOW and the SPOTLIGHT. And across both studies, the hazard ratio for the overall survival was 0.78, and similarly, there was also an improvement in progression-free survival favoring the zolbetuximab group compared to the chemotherapy group alone. An important note is that nausea, vomiting is commonly associated with zolbetuximab-based treatments, and the panel recommended prophylactic antiemetics, adjusting zolbetuximab infusion rates, pausing infusion temporarily, using non-prophylactic antiemetics, and hydration intravenously prior to discontinuation of zolbetuximab-based chemotherapy. So effective handling of the GI-related symptoms with zolbetuximab is recommended prior to discontinuation of therapy. Now, for patients with pMMR microsatellite stable HER2-negative gastric, GE junction adenocarcinoma with PD-L1 expression greater than 1 and CLDN18.2 positivity, the ones with the dual expression with CLDN18.2 as well as PD-L1 chemotherapy, the choice of therapy can be based on the degree of PD-L1 expression, the toxicity profile, the burden of symptoms, and the anticipated improvement in symptoms associated with response to treatment, the patient comorbidities, the prior medical and treatment history. So this decision needs to be made on a case-by-case basis, and these are some of the factors that we suggested that could potentially influence the choice of therapy. For patients with pMMR microsatellite stable disease that is HER2-negative and a PD-L1 expression less than 1 and an absence of CLDN18.2 expression, first-line therapy with fluoropyrimidine and platinum-based chemotherapy is recommended. So you can see we have segmented out patients based on PD-L1 expression, pMMR and microsatellite stable disease expression, and also based on CLDN expression. Brittany Harvey: Absolutely. And that first point you noted, I think is really important, that biomarker testing is really critical for treatment decision-making in this space. So then the next subgroup of patients that the panel looked at, Dr. Shah, what first-line therapy is recommended for patients with proficient mismatch repair, microsatellite stable, HER2-positive gastroesophageal adenocarcinoma? Dr. Manish Shah: So this was an update from a few years ago. So we have known for 15 years now that if you are HER2-positive, you should get trastuzumab plus chemotherapy. That was based on the ToGA trial. And the update now is based on a trial called KEYNOTE-811, where it examined the addition of pembrolizumab to trastuzumab and chemotherapy versus trastuzumab and chemotherapy, and there was a progression-free and overall survival benefit. And again, here, the biomarkers are important. If your CPS PD-L1 is less than 1, we would not recommend Pembrolizumab in that setting, so you would still get trastuzumab and chemotherapy. But if it is 1 or greater, the PD-L1 CPS score, then we do recommend pembrolizumab unless there is a contraindication to immunotherapy. The take-home message really is from the onset of diagnosis, please check your biomarkers. And I will just, it is worth repeating, it is important to check your PD-L1 status, HER2 status, mismatch repair status, and CLDN18.2 status. And then the optimal therapy, and it is outlined in the publication, is really biomarker-driven. We know that if we are able to hit the target that is overexpressed, we are going to have a better outcome. And Dr. Rajdev did mention where there is overlap, there can be a lack of data, and that is where we are with both PD-L1 positive and CLDN positive. Here we do have data in HER2-positive cases where if you are both HER2-positive and PD-L1 positive, you would combine trastuzumab and pembrolizumab for the best outcomes. Brittany Harvey: Understood. I really appreciate you detailing what is most important for each individual biomarker combination that patients may have. So then following that, Dr. Rajdev, what does the expert panel recommend for first-line treatment for patients with esophageal squamous cell carcinoma that is not amenable to definitive chemoradiation? Dr. Lakshmi Rajdev: There are three phase III randomized clinical trials that have influenced practice in patients with esophageal squamous cell carcinoma examining the benefit of immunotherapy in this patient population. The RATIONALE-306 was a randomized trial of tislelizumab plus chemotherapy with platinum and fluoropyrimidine or paclitaxel versus placebo with chemotherapy. And then you have the KEYNOTE-590, which compared pembrolizumab plus chemotherapy versus chemotherapy alone. And then you have CheckMate-648, which included comparisons of nivolumab plus chemotherapy versus nivolumab plus ipilimumab or chemotherapy. And the primary endpoints for these studies were overall survival, and they did look at subgroups with PD-L1 expression. They used TPS score greater than 1% in CheckMate-648 and PD-L1 CPS greater than 10 in KEYNOTE-590. The bottom line is that the overall hazard ratio for overall survival across this patient population was 0.72. So clearly, there is benefit in patients that express PD-L1 CPS greater than 1 for benefit for the addition of immunotherapy. Now, the benefit again in patients with a PD-L1 expression less than 1 remains limited, and so the panel has made a recommendation for using immunotherapy in combination with platinum-based chemotherapy in patients with a PD-L1 greater than 1. Again, we know that it is hard to make recommendations on what PD-L1 cutoffs are recommended in this patient population, meaning that should it be limited to patients with a PD-L1 of 1 to 4 or greater than 10? I think that the general consensus that has been gleaned from the data is that the higher the PD-L1 expression, the greater the benefit. I do want to comment on another option that is available in patients with squamous cell carcinoma compared to adenocarcinoma, and that is the combination of nivolumab and ipilimumab. Now, in CheckMate-648, nivolumab with ipilimumab was also recommended as a treatment option in patients that have a PD-L1 score of greater than 1. There was a survival benefit demonstrated with this combination compared to chemotherapy alone. And an important observation in this study is that, although there was a slightly increased rate in early death, but there was really no significant difference in PFS and OS compared to chemotherapy alone. Importantly, the treatment appeared to be pretty well tolerated by the study population. There was a notable difference in the objective response rate, which was 35% in the nivolumab plus ipilimumab group compared to patients receiving nivolumab and chemotherapy, where it was 53%. So superiority is, so the importance of chemotherapy in patients with esophageal squamous cell carcinoma is to be noted. However, there is no difference in overall survival and progression-free survival when using the combination of nivolumab and ipilimumab, and thus it affords a chemotherapy-free option for this patient population with esophageal squamous cell carcinoma and a CPS with a score of greater than 1. Brittany Harvey: Understood. I appreciate you reviewing the evidence underpinning those recommendations as well. So then the next patient population that the guideline panel addressed, what first-line therapy is recommended for patients with deficient mismatch repair, microsatellite instability-high, gastroesophageal adenocarcinoma or esophageal squamous cell carcinoma? Dr. Lakshmi Rajdev: The rate of MSI-high expression is about 3% to 7% across different studies. Now, the KEYNOTE-158 was a tumor-agnostic study in patients with non-colorectal cancers, and again, the problem with the MSI-high population, given that it is so rare, the numbers in the individual studies are fairly small. But consistent outcomes do emerge, indicating high response to immunotherapy. So in KEYNOTE-158, a response rate of about 46% was noted. The number of patients was small, it was about 24. In CheckMate-649, which is a study of chemotherapy plus or minus nivolumab in patients with advanced gastric adenocarcinoma, there was again a very small number of patients, and patients that were MSI-high or deficient MMR did experience substantial benefits with the addition of immunotherapy, with hazard ratios in the order of about 0.38. In KEYNOTE-062, again, it was a very small number of patients, again about 6% or so, and similar to CheckMate-649, a substantial benefit was noted in combination with chemotherapy, but also there were benefits noted with pembrolizumab alone. The RATIONALE-305 again was a study of tislelizumab in combination with chemotherapy and similarly showed benefits to the combination of chemotherapy plus immunotherapy in this patient population. I think that we are all aware of the dramatic benefits of immunotherapy in this particular subset of patients, deficient MMR MSI-high, and also we have seen in CheckMate-649 they did have a subset of patients that received nivolumab and ipilimumab. And in this patient population, they noted unstratified hazard ratio of 0.28. So I think that the overall consensus is that immunotherapy is a very important treatment modality in patients with deficient MMR MSI-high disease, given that a lot of the trials in gastroesophageal adenocarcinoma have utilized chemotherapy-based options, that is certainly a recommendation of the panel to use chemotherapy in combination with immunotherapy. However, on a case-by-case basis, the panel recommended immunotherapy alone as well, and given the high response rates noted in trials across different diseases as well as noted in this disease as well. Brittany Harvey: Certainly. And I appreciate you both for reviewing these first-line recommendations. So moving to later lines of therapy, Dr. Rajdev, what recommendations did the expert panel make for second or third-line therapy for gastroesophageal adenocarcinoma and esophageal squamous cell carcinoma? Dr. Lakshmi Rajdev: So, I think that the RAINBOW trial that investigated the utility of the addition of ramucirumab as second-line therapy has been around since 2014, and those results have led to the addition of ramucirumab to taxane-based therapy in the second-line setting. Based on the utilization of oxaliplatin and platinum-based therapy in the front-line setting, there may be patients that have an underlying neuropathy, and so we wanted to really include treatment options for this patient population so that an agent that is less neurotoxic could also be recommended in combination with ramucirumab. The RAMIRIS trial is one such trial where ramucirumab was combined with FOLFIRI, and it demonstrated benefit in combination with ramucirumab. So we have listed that as a potential treatment option for patients in the second-line setting who may have an underlying neuropathy or even for whatever reason that based on the toxicity profile, that needs to be the preferred option by a physician, that recommendation is new from the older guidelines that we have. With regard to the utility of PD-1 inhibitors, there really has been no benefit noted in the second-line setting with regard to overall survival or progression-free survival, so no recommendation is made for that option. I think an important study that has been recently presented is the DESTINY-Gastric04 trial, which really has been practice-changing and has led to the recommendation for trastuzumab deruxtecan in patients that have HER2-positive metastatic gastric or GE junction adenocarcinoma. Now, this is a phase III trial in patients who retained HER2-positive disease after progressing on front-line trastuzumab-based treatments, and the comparator for this trial was trastuzumab deruxtecan versus ramucirumab plus paclitaxel. There was significant improvement and progression-free survival in patients that received trastuzumab deruxtecan. The patients that were excluded from the trial are patients that have pulmonary problems, interstitial lung disease; that is one of the toxicities of this particular agent, and close monitoring and prompt initiation of therapy such as glucocorticoid treatment in patients who develop this toxicity was also highlighted by the panel. So to summarize, the new guidelines highlight the possibility of FOLFIRI plus ramucirumab as a second-line option and then trastuzumab deruxtecan as a later-line option in patients that still retain HER2 expression. And that is very important because the trial did retest patients whether they expressed HER2. As we know, in a substantial number of patients, there is downregulation of HER2, and there is emerging data that the benefit for subsequent HER2-directed therapies is best noted in patients that still retain HER2 expression. Brittany Harvey: Great. So as our listeners have heard, there are many recommendations and new treatment options for advanced gastroesophageal cancer. Dr. Shah, earlier you highlighted the importance of biomarker testing, but I would like to hear in your view, what is the importance of this guideline and how will it impact both clinicians and patients with gastroesophageal carcinoma? Dr. Manish Shah: So as we have discussed throughout this podcast, the treatment for gastroesophageal cancer, both adenocarcinoma and squamous cell cancer, is increasingly complex, increasingly biomarker-driven. And I think the value of the guideline is to place all of that into context. So it provides the data for why certain biomarkers are important, what therapies should be indicated. Not only that, but if you are able to review the guideline, it provides the details of each of these studies and summarizes them in a meta-analysis fashion to sort of give you the context, because sometimes the individual studies can be maybe a little bit discordant or confusing and the guideline attempts to harmonize all that. And then also, I think the tables are very, very interesting because they give you actual numbers in terms of how many patients over a thousand would this benefit or how many patients over a thousand would this cause harm in terms of nausea, vomiting, or other things like that. So it gives you context for helping clinicians and patients weigh the potential benefits of the novel treatment strategies against the potential adverse events. And then finally, the guideline does also provide an algorithm that you are able to follow based on the biomarkers, and those are in figures 4 and 5. So I think overall, it is a very comprehensive guideline. It intends to make more manageable a very complex subject, and you know, I really encourage our listeners to review it after listening to the podcast. Dr. Lakshmi Rajdev: If I can add to that, I think that what is also really good about the guidelines is there are quick summaries. So if someone is busy in the clinic, of course, there is the opportunity to review the data supporting the guidelines in great depth in the manuscript, but what is also really good is that there are good summaries. In the event that you are very busy, you can easily identify what the recommendations should be for that particular patient based on these summaries. Brittany Harvey: Absolutely. Listeners are encouraged to review the full guideline, including those tables and figures that may be more helpful when they are looking for something quick to look at in the clinic as well. So, as you both mentioned, there have been a number of recent practice-changing trials in this area. So I imagine there is still a lot of ongoing research as well. So Dr. Shah, what are the outstanding questions regarding treatment options for patients with locally advanced unresectable, advanced, or metastatic gastroesophageal carcinoma? Dr. Manish Shah: I think we touched upon it a little bit. The guidelines are based on the data available, and they are primarily examining one novel therapy with chemotherapy in a specific biomarker population. But as you know, the biomarkers are not either/or; you are not either CLDN18.2 positive or PD-L1 positive. A portion of patients could have dual biomarkers, and you know, I think that we are generating data on how to manage those patients. At the recent GI Symposium in January this year, the ILUSTRO trial was presented by Dr. Shitara, which looked at combining zolbetuximab and chemotherapy with immunotherapy for dual-positive biomarkers, and that is leading to a phase III study that has begun to enroll. So unanswered questions are: how do we manage dual-positive biomarkers? The other thing that was mentioned is that the current data for mismatch repair deficiency involve chemotherapy plus immunotherapy. Only squamous cell cancer is there a study with a positive non-chemotherapy kind of backbone, that is CheckMate-648 that Dr. Rajdev mentioned. As we move forward, it will be good to get data on non-chemotherapy options in certain biomarker-positive populations. And then finally, another update, which is likely to be practice-changing, is the HERIZON-GEA-01 study that looked at zanidatamab, which is another biparatopic antibody that targets HER2, and that is likely to change practice. And as that data gets published, we may look to even do a rapid update for the current immunotherapy and targeted therapy guideline that is just being published. Dr. Lakshmi Rajdev: So, if I can add to that, there are numerous ADCs that look very interesting. There are bispecific antibodies; in fact, the zanidatamab is a bispecific antibody showing improved activity in patients with HER2-positive disease. So I think there are studies from Asia looking at CLDN CAR T-based therapies. So, I think that there are a lot of novel agents and a lot of excitement in the field. We know that the bemarituzumab study, unfortunately, the FGFR2 inhibitor failed to demonstrate any benefit, but I think that there are other agents that are being explored, so there are newer targets, newer agents, ADCs, bispecifics that could potentially change the field in the future. Brittany Harvey: Yes, we will look forward to the data to address these unanswered questions and new agents and inform future guideline updates. So, I would like to thank you both for all of your work to review the evidence here and update this important guideline, and for your time today, Dr. Rajdev and Dr. Shah. Dr. Lakshmi Rajdev: Thank you. Dr. Manish Shah: Thank you. Brittany Harvey: And finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/gastrointestinal-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Dr. Pedro Barata and Dr. Ugwuji Maduekwe discuss the evolving treatment landscape in gastroesophageal junction and gastric cancers, including the emergence of organ preservation as a selective therapeutic goal, as well as strategies to mitigate disparities in care. Dr. Maduekwe is the senior author of the article, "Organ Preservation for Gastroesophageal Junction and Gastric Cancers: Ready for Primetime?" in the 2026 ASCO Educational Book. TRANSCRIPT Dr. Pedro Barata: Hello, and welcome to By the Book, a podcast series from ASCO that features compelling perspectives from authors and editors of the ASCO Educational Book. I'm Dr. Pedro Barata. I'm a medical oncologist at University Hospitals Seidman Cancer Center and an associate professor of medicine at Case Western Reserve University in Cleveland, Ohio. I'm also the deputy editor of the ASCO Educational Book. Gastric and gastroesophageal cancers are the fifth most common cancer worldwide and the fourth leading cause of cancer-related mortality. Over the last decade, the treatment landscape has evolved tremendously, and today, organ preservation is emerging as an attainable but still selective therapeutic goal. Today, I'm delighted to be speaking with Dr. Ugwuji Maduekwe, an associate professor of surgery and the director of regional therapies in the Division of Surgical Oncology at the Medical College of Wisconsin. Dr. Maduekwe is also the last author of a fantastic paper in the 2026 ASCO Educational Book titled "Organ Preservation for Gastroesophageal Junction and Gastric Cancers: Ready for Prime Time?" We explore these questions in our conversations today.  Our full disclosures are available in the transcript of this episode as well. Welcome. Thank you for joining us today. Dr. Ugwuji Maduekwe: Thank you, Dr. Barata. I'm really, really glad to be here. Dr. Pedro Barata: There's been a lot of progress in the treatment of gastric and gastroesophageal cancers. But before we actually dive into some of the key take-home points from your paper, can you just walk us through how systemic therapy has emerged and actually allowed you to start thinking about a curative framework and really informing surgery decision-making? Dr. Ugwuji Maduekwe: Great, thank you. I'm really excited to be here and I love this topic because, I'm terrified to think of how long ago it was, but I remember in medical school, one of my formative experiences and why I got so interested in oncology was when the very first trials about imatinib were coming through, right? Looking at the effect, I remember so vividly having a lecture as a first-year or second-year medical student, and the professor saying, "This data about this particular kind of cancer is no longer accurate. They don't need bone marrow transplants anymore, they can just take a pill." And that just sounded insane. And we don't have that yet for GI malignancies. But part of what is the promise of precision oncology has always been to me that framework. That framework we have for people with CML who don't have a bone marrow transplant, they take a pill. For people with GIST. And so when we talk about gastric cancers and gastroesophageal cancers, I think the short answer is that systemic therapy has forced surgeons to rethink what "necessary" really means, right? We have the old age saying, "a chance to cut is a chance to cure." And when I started out, the conversation was simple. We diagnose the cancer, we take it out. Surgery's the default. But what's changed really over the last decade and really over the last five years is that systemic therapy has gotten good enough to do what is probably real curative work before we ever enter the operating room. So now when you see a patient whose tumor has essentially melted away on restaging, the question has to shift, right? It's no longer just, "Can I take this out?" It's "Has the biology already done the heavy lifting? Have we already given them systemic therapy, and can we prove it safely so that maybe we don't have to do what is a relatively morbid procedure?" And that shift is what has opened the door to organ preservation. Surgery doesn't disappear, but it becomes more discretionary. Necessary for the patients who need it, and within systems that can allow us to make sure that we're giving it to the right patients. Dr. Pedro Barata: Right, no, that makes total sense. And going back to the outcomes that you get with these systemic therapies, I mean, big efforts to find effective regimens or cocktails of therapies that allow us to go to what we call "complete response," right? Pathologic complete response, or clinical complete response, or even molecular complete response. We're having these conversations across different tumors, hematologic malignancies as well as solid tumors, right? I certainly have those conversations in the GU arena as well. So, when we think of pathologic CRs for GI malignancies, right? If I were to summarize the data, and please correct me if I'm wrong, because I'm not an expert in this area, the traditional perioperative chemo gives you pCRs, pathologic complete response, in the single digits. But then when you start getting smarter at identifying biologically distinct tumors such as microsatellite instability, for instance, now you start talking about pCRs over 50%. In other words, half of the patients' cancer goes away, it melts down by offering, in this case, immunotherapy as a backbone of that neoadjuvant. But first of all, this shift, right, from going from these traditional, "not smart" chemotherapy approaches to kind of biologically-driven approaches, and how important is pCR in the context of "Do I really need surgery afterwards?" Dr. Ugwuji Maduekwe: That's really the crux of the entire conversation, right? We can't proceed and we wouldn't be able to have the conversation about whether organ preservation is even plausible if we hadn't been seeing these rates of pathologic complete response. If there's no viable tumor left at resection, did surgery add something? Are we sure? The challenge before this was how frequently that happened. And then the next one is, as you've already raised, "Can we figure that out without operating?" In the traditional perioperative chemo era, pathologic complete response was relatively rare, like maybe one in twenty patients. When we go to more modern regimens like FLOT, it got closer to one in six. When you add immunotherapy in recent trials like MATTERHORN, it's nearly triple that rate. And it's worth noting here, I'm a health services-health disparities researcher, so we'll just pause here and note that those all sound great, but these landmark trials have significant representation gaps that limit and should inform how confidently we generalize these findings. But back to what you just said, right, the real inflection point is MSI-high disease where, with neoadjuvant dual-checkpoint blockade, trials like NEONIPIGAS and INFINITY show pCR rates that are approaching 50% to 60%. That's not incremental progress, that's a whole new different biological reality. What does that mean? If we're saying that 50% to 60% of the people we take to the OR at the time of surgery will end up having no viable tumor, man, did we need to do a really big surgery? But the problem right now is the gold standard, I think we would mostly agree, the gold standard is pathologic complete response, and we only know that after surgery. I currently tell my patients, right, because I don't want them to be like, "Wait, we did this whole thing." I'm like, "We're going to do this surgery, and my hope is that we're going to do the surgery and there will be no cancer left in your stomach after we take out your stomach." And they're like, "But we took out my stomach and you're saying it's a good thing that there's no cancer." And yes, right now that is true because it's a measure of the efficacy of their systemic therapy. It's a measure of the biology of the disease. But should we be acting on this non-operatively? To do that, we have to find a surrogate. And the surrogate that we have to figure out is complete clinical response. And that's where we have issues with the stomach. In esophageal cancer, the preSANO protocol, which we'll talk about a little bit, validated a structured clinical response evaluation. People got really high-quality endoscopies with bite-on biopsies. They got endoscopic ultrasounds. They got fine-needle aspirations and PET-CT, and adding all of those things together, the miss rate for substantial residual disease was about 10% to 15%. That's a number we can work with. In the stomach, it's a lot more difficult anatomically just given the shape of people's stomachs. There's fibrosis, there's ulceration. A fair number of stomach and GEJ cancers have diffuse histology which makes it difficult to localize and they also have submucosal spread. Those all conceal residual disease. I had a recent case where I scoped the patient during the case, and this person had had a 4 cm ulcer prior to surgery, and I scoped and there was nothing visible. And I was elated. And on the final pathology they had a 7 cm tumor still in place. It was just all submucosal. That's the problem. I'm not a gastroenterologist, but I would have said this was a great clinical response, but because it's gastric, there was a fair amount of submucosal disease that was still there. And our imaging loses accuracy after treatment. So the gap between what looks clean clinically and what's actually there pathologically remains very wide. So I think that's why we're trying to figure it out and make it cleaner. And outside of biomarker-selected settings like MSI-high disease, in general, I'm going to skip to the end and our upshot for the paper, which is that organ preservation, I would say for gastric cancer particularly, should remain investigational. I think we're at the point where the biology is increasingly favorable, but our means of measurement is not there yet. Dr. Pedro Barata: Gotcha. So, this is a perfect segue because you did mention the SANO, just to spell it out, "Surgery As Needed for Oesophageal" trial, so SANO, perfect, I love the abbreviation. It's really catchy. It's fantastic, it's actually a well-put-together perspective effort or program applying to patients. And can you tell us how was that put together and how does that work out for patients? Dr. Ugwuji Maduekwe: Yeah, I think for those of us in the GI space, we have SANO and then we also have the OPRA for rectum. SANO for the upper GI is what takes organ preservation from theory to something that's clinically credible. The trial asked a very simple question. If a patient with a GEJ adenocarcinoma or esophageal adenocarcinoma achieved what was felt to be a clinical complete response after chemoradiation, would they actually benefit from immediate surgery? And the question was, "Can you safely observe?" And the answer was 'yes'. You could safely observe, but only if you do it right. And what does that mean? At two years, survival with active surveillance was not inferior to those who received an immediate esophagectomy. And those patients had a better early quality of life. Makes sense, right? Your quality of life with an esophagectomy versus not is going to be different. That matters a lot when you consider what the long-term metabolic and functional consequences of an esophagectomy are. The weight loss, nutritional deficiencies that can persist for years. But SANO worked because it was very, very disciplined and not permissive. You mentioned rigor. They were very elegant in their approach and there was a fair amount of rigor. So there were two main principles. The first was that surveillance was front-loaded and intentional. So they had endoscopies with biopsies and imaging every three to four months in the first year and then they progressively spaced it out with explicit criteria for what constituted failure. And then salvage surgery was pre-planned. So, the return-to-surgery pathway was already rehearsed ahead of time. If disease reappeared, take the patient to the OR within weeks. Not sit, figure out what that means, think about it a little bit and debate next steps. They were very clear about what the plan was going to be. So they've given us this blueprint for, like, watching people safely. I think what's remarkable is that if you don't do that, if you don't have that infrastructure, then organ preservation isn't really careful. It's really hopeful. And that's what I really liked about the SANO trial, aside from, I agree, the name is pretty cool. Dr. Pedro Barata: Yeah, no, that's a fantastic point. And that description is spot on. I am thinking as we go through this, where can this be adopted, right? Because, not surprisingly, patients are telling you they're doing a lot better, right, when you don't get the esophagus out or the stomach out. I mean, that makes total sense. So the question is, you know, how do you see those issues related to the logistics, right? Getting the multi-disciplinary team, getting the different assessments of CR. I guess PETs, a lot of people are getting access to imaging these days. How close do you think this is, this kind of program, to be implemented? And maybe I would assume it might need to be validated in different settings, right, including the community. How close or how far do you think you see that being applied out there versus continuing to be a niche program, watch and wait program, in dedicated academic centers? Dr. Ugwuji Maduekwe: I love this question. So I said at the top of this, I'm a health equity/health disparities researcher, and this is where I worry the most. I love the science of this. I'm really excited about the science. I'm very optimistic. I don't think this is a question of "if," I think it's a question of "when." We are going to get to a point where these conversations will be very, very reasonable and will be options. One of the things I worry about is: who is it going to be an option for? Organ preservation is not just a treatment choice, and I think what you're pointing out very rightly is it's a systems-level intervention. Look at what we just said for SANO. Someone needs to be able to do advanced endoscopy, get the patients back. We have to have the time and space to come back every three to four months. We have to do molecular testing. There needs to be multi-disciplinary review. There needs to be intensive surveillance, and you need to have rapid access to salvage surgery. Where is that infrastructure? In this country, it's mostly in academic centers. I think about the panel we had at ASCO GI, which was fantastic. And as we were having the conversation, you know, we set it up as a debate. So folks were debating either pro-surveillance or pro-surgery. But both groups, both people, were presenting outcomes based on their centers. And it was folks who were fantastic. Dr. Molena, for example, from Memorial Sloan Kettering was talking about their outcomes in esophagectomies [during our session at GI26], but they do hundreds of these cases there per year. What's the reality in this country? 70% to 80% to 90%, depending on which data you look at, of the gastrectomies in the United States occur at low-volume hospitals. Most of the patients at those hospitals are disproportionately uninsured or on government insurance, have lower income and from racial and ethnic minority groups. So if we diffuse organ preservations without the system to support it, we're going to create a two-tiered system of care where whether you have the ability to preserve your organs, to preserve bodily integrity, depends on where you live and where you're treated. The other piece of this is the biomarker testing gap. One of the things that, as you pointed out at the beginning, that's really exciting is for MSI-high tumors. Those are the patients that are most likely to benefit from immunotherapy-based organ preservation. But here's the problem. If the patient isn't tested at time of initial diagnosis before they ever see me as a surgeon, the door to organ preservation is closed before it's ever open. And testing access remains very inconsistent across academic networks. And then there's the financial toxicity piece where, for gastrectomy, pancreatectomy, I do peritoneal malignancies, more than half of those patients experience significant financial toxicity related to their cancer treatment. We're now proposing adding at least two years, that's the preliminary information, right? It's probably going to be longer. At least a couple of years of surveillance visits, repeated endoscopies, immunotherapy costs. How are we going to support patients through that? We're going to have to think about setting up navigation support, geographic solutions, what financial counseling looks like. My patient for clinic yesterday was driving to see me, and they were talking about how they were sliding because it was snowing. And they were sliding for the entire three-hour drive down here. Are we going to tell people like that that they need to drive down to, right, I work at a high-volume center, they're going to need to come here every three months, come rain or snow, to get scoped as opposed to the one-time having a surgery and not needing to have the scopes as frequently? My concern, like I said, I'm an optimist, I think it is going to work. I think we're going to figure out how to make it work. I'm worried about whether when we deploy it, we widen the already existing disparities. Dr. Pedro Barata: Gotcha, and that's a fantastic summary. And as I'm thinking also of what we've been talking in other solid tumors, which one of the following do you think is going to evolve first? So we are starting to use more MRD-based assays, which are based on blood test, whether it's a tumor-informed ctDNA or non-informed. We are also trying to get around or trying to get more information response to systemic therapies out of RNA-seq through gene expression signatures, or development of novel therapeutics which also can help you there. Which one of these areas you think you're going to help this SANO-like approach move forward, or you actually think it's actually all of the above, which makes it even more complicated perhaps? Dr. Ugwuji Maduekwe: I think it's going to be all of the above for a couple of reasons. I would say if I had to pick just one right now, I think ctDNA is probably the most promising and potentially the missing piece that can help us close the gap between clinical and pathologic response. If you achieve clinical complete response and your ctDNA is negative, so you have clinical and molecular evidence of clearance, maybe that's a low-risk patient for surveillance. If you have clinical complete response but your ctDNA remains positive, I would say you have occult molecular disease and we probably need intensified therapy, closer monitoring, not observation. I think the INFINITY trial is already incorporating ctDNA into its algorithm, so we'll know. I don't think we're at the point where it alone can drive surgical decisions. I think it's going to be a good complement to clinical response evaluation, not a replacement. The issue of where I think it's probably going to be multi-dimensional is the evidence base: who are we testing? Like, what is the diversity, what is the ancestral diversity of these databases that we're using for all of these tests? How do we know that ctDNA levels and RNA-seq expression arrays are the same across different ancestral groups, across different disease types? So I think it's probably going to be an amalgam and we're going to have to figure out some sort of algorithm to help us define it based on the patient characteristics. Like, I think it's probably different, some of this stuff is going to be a little bit different depending on where in the stomach the cancer is. And it's going to be a little bit more difficult to figure out if you have a complete clinical response in the antrum and closer to the pylorus, for example. That might be a little bit more difficult. So maybe the threshold for defining what a clinical complete response needs to be is higher because the therapeutic approach there is not quite as onerous as for something at the GE-junction. Dr. Pedro Barata: Wonderful. And I'm sure AI, whether it's digitization of the pathology from the biopsies and putting all this together, probably might play a role as well in the future.  Dr. Maduekwe, it's been fantastic. Thank you so much for sharing your insights with us and also congrats again for the really well-done review published.  For our listeners, thank you for staying with us. Thank you for your time. We will post a link to this fantastic article we discussed today in the transcript of this episode. And of course, please join us again next month on the By the Book Podcast for more insights on key advances and innovations that are shaping modern oncology. Thank you, everyone. Dr. Ugwuji Maduekwe: Thank you. Thank you for having me. Watch the ASCO GI26 session: Organ Preservation for Gastroesophageal and Gastric Cancers: Ready for Primetime? Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:          Dr. Pedro Barata   @PBarataMD    Dr. Ugwuji Maduekwe @umaduekwemd Follow ASCO on social media:          @ASCO on X (formerly Twitter)          ASCO on Bluesky         ASCO on Facebook          ASCO on LinkedIn          Disclosures:       Dr. Pedro Barata:   Stock and Other Ownership Interests: Luminate Medical   Honoraria: UroToday   Consulting or Advisory Role: Bayer, BMS, Pfizer, EMD Serono, Eisai, Caris Life Sciences, AstraZeneca, Exelixis, AVEO, Merck, Ipson, Astellas Medivation, Novartis, Dendreon   Speakers' Bureau: AstraZeneca, Merck, Caris Life Sciences, Bayer, Pfizer/Astellas   Research Funding (Inst.): Exelixis, Blue Earth, AVEO, Pfizer, Merck    Dr. Ugwuji Maduekwe: Leadership: Medica Health Research Funding: Cigna    

Featuring perspectives from Dr Jaffer A Ajani, Dr Samuel J Klempner, Dr Rutika Mehta and Dr John Strickler, moderated by Dr Klempner, including the following topics:  Introduction (0:00) HER2-Targeted Approaches for Advanced Gastroesophageal Cancers — Dr Ajani (2:02) Faculty Panel Discussion: Cases and Questions from the Community (14:13) Targeting Claudin 18.2 in Advanced Gastroesophageal Cancers — Dr Strickler (37:29) Faculty Panel Discussion: Cases and Questions from the Community (49:21) Optimal Incorporation of Immunotherapeutic Strategies into Treatment for Patients with Metastatic Gastroesophageal Tumors — Dr Mehta (1:09:56) Faculty Panel Discussion: Cases and Questions from the Community (1:22:02) Other Novel Agents and Strategies Under Evaluation for Advanced Gastroesophageal Cancers — Dr Klempner (1:44:23) CME information and select publications

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, Dr John Strickler from Duke University in Durham, North Carolina, and Dr Samuel Klempner from Massachusetts General Hospital in Boston review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, Dr John Strickler from Duke University in Durham, North Carolina, and Dr Samuel Klempner from Massachusetts General Hospital in Boston review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Dr Jaffer Ajani from The University of Texas MD Anderson Cancer Center in Houston, Dr Rutika Mehta from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York, New York, Dr John Strickler from Duke University in Durham, North Carolina, and Dr Samuel Klempner from Massachusetts General Hospital in Boston review relevant data supporting immunotherapy for patients with gastroesophageal cancers and review recently presented clinical findings from the 2026 ASCO Gastrointestinal Cancers Symposium.CME information and select publications here.

Guest: Daniela Molena, MD For patients with locally advanced gastroesophageal cancer, surgery remains a critical component of curative treatment—even in the era of chemoradiation and advanced imaging. Dr. Daniela Molena explores the challenges of assessing complete clinical response and the risks of non-operative management. Dr. Molena is an Associate Professor of Surgery at Weill Cornell Medicine and a Thoracic Surgeon at Memorial Sloan Kettering Cancer Center, and she discussed this topic at the 2026 ASCO Gastrointestinal Cancers Symposium.

Guest: Daniela Molena, MD For patients with locally advanced gastroesophageal cancer, surgery remains a critical component of curative treatment—even in the era of chemoradiation and advanced imaging. Dr. Daniela Molena explores the challenges of assessing complete clinical response and the risks of non-operative management. Dr. Molena is an Associate Professor of Surgery at Weill Cornell Medicine and a Thoracic Surgeon at Memorial Sloan Kettering Cancer Center, and she discussed this topic at the 2026 ASCO Gastrointestinal Cancers Symposium.

In this episode of SurgOnc Today's Surgical Oncology Insight series, Dr. Monisha Sudarshan, Section Editor of the Thoracic Editorial Board section, discusses with Dr. Erin A. Gillaspie her paper "Immunotherapy in gastroesophageal adenocarcinoma: What is the state of management?".

Featuring perspectives from Dr Yelena Y Janjigian, including the following topics: Introduction (0:00) Case: A man in his early 60s with a history of Barrett's esophagus presents with HER2-positive metastatic esophageal adenocarcinoma and a PD-L1 combined positive score (CPS) of 3 — Jennifer Yannucci, MD (10:20) Case: A man in his early 60s with multiregimen-recurrent HER2-positive gastroesophageal junction (GEJ) adenocarcinoma (claudin 18.2-positive, PD-L1 CPS 0) — Neil Morganstein, MD (14:53) Case: A woman in her early 80s with dementia and newly diagnosed mismatch repair-deficient, PD-L1-positive metastatic GEJ adenocarcinoma — Brian P Mulherin, MD (25:55) Case: A man in his mid 60s with localized HER2-negative GEJ cancer (PD-L1 CPS 2, claudin 18.2-positive) and residual disease after receiving neoadjuvant chemoradiation therapy and undergoing surgery — Stephen "Fred" Divers, MD (32:18) Case: A man in his early 80s with metastatic recurrence of esophageal adenocarcinoma and a PD-L1 total proportion score of 75% 2 years after resection of localized disease — Susmitha Apuri, MD (40:28) Case: A man in his mid 70s with claudin 18.2-positive metastatic esophageal adenocarcinoma who develops progressive toxicities with FOLFOX and zolbetuximab — Sean Warsch, MD (52:54) CME information and select publications

Dr Yelena Janjigian from Memorial Sloan Kettering Cancer Center in New York, New York, discusses updates across the treatment landscape for gastroesophageal cancers, as well as real-world clinical case examples.CME information and select publications here.

Dr Yelena Janjigian from Memorial Sloan Kettering Cancer Center in New York, New York, discusses updates across the treatment landscape for gastroesophageal cancers, as well as real-world clinical case examples.CME information and select publications here.

Dr Yelena Janjigian from Memorial Sloan Kettering Cancer Center in New York, New York, discusses updates across the treatment landscape for gastroesophageal cancers, as well as real-world clinical case examples.CME information and select publications here.

Featuring perspectives from Dr Manish A Shah, moderated by Dr Stephen "Fred" Divers, including the following topics:  Highlights and Principles of Management of Metastatic Gastric and Gastroesophageal Junction Adenocarcinoma — Dr Shah (0:00) Case: A man in his early 50s with microsatellite instability-high localized esophageal adenocarcinoma — Dr Mulherin (15:24) Case: A woman in her late 60s with HER2-positive (IHC 3+) and HER2 TKD-mutant metastatic esophageal adenocarcinoma — Dr Warsch (25:34) Case: A woman in her early 70s with HER2-positive (IHC 3+), PD-L1-negative, CLDN18.2-negative metastatic gastric cancer — Dr Mulherin (28:15) Case: A woman in her early 70s with metastatic gastroesophageal junction adenocarcinoma (PD-L1 CPS 15) who begins treatment with FOLFOX/nivolumab and subsequently is found to have CLDN18.2 overexpression — Dr Lamar (35:23) Case: A man in his mid 40s with CLDN18.2-positive metastatic esophageal adenocarcinoma (PD-L1 10%) who receives mFOLFOX6 and zolbetuximab — Dr Yannucci (42:54) CE information and select publications

Dr Manish A Shah from Weill Cornell Medicine in New York, New York, summarizes the treatment landscape and reviews relevant clinical datasets for patients with gastroesophageal cancers. CME information and select publications here.

Dr Manish A Shah from Weill Cornell Medicine in New York, New York, summarizes the treatment landscape and reviews relevant clinical datasets for patients with gastroesophageal cancers. CME information and select publications here.

Dr Manish A Shah from Weill Cornell Medicine in New York, New York, summarizes the treatment landscape and reviews relevant clinical datasets for patients with gastroesophageal cancers. CME information and select publications here.

Learn which HER2-targeted therapies are being evaluated for the first-line treatment of gastroesophageal adenocarcinoma. Credit available for this activity expires: 11/27/2026 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/her2-evolution-gastroesophageal-cancer-new-therapies-and-2025a1000x2t?ecd=bdc_podcast_libsyn_mscpedu

Are you ready for the evolving treatment paradigm in HER2-positive gastroesophageal adenocarcinoma (GEA) and biliary tract cancer (BTC)? Credit available for this activity expires: 10/24/27 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/her2-positive-gastroesophageal-adenocarcinoma-and-biliary-2025a1000sr3?&ecd=bdc_podcast_libsyn_mscpedu

In this podcast episode, Amit Mahipal, MD, MPH, and Shubham Pant, MD, discuss new and emerging therapies for the personalized care of patients with HER2-positive gastroesophageal adenocarcinoma (GEA) and biliary tract cancer (BTC), including:Brief overview of BTC and GEAApproved HER2-directed therapies for BTC and GEA and their mechanisms of actionEfficacy and toxicities of the approved agents and optimal management strategiesKey ongoing trials of HER2-directed therapies in BTC and GEAChallenges faced by healthcare professionals in the management of patients with BTC and/or GEA PresentersAmit Mahipal, MD, MPHDirector, Gastrointestinal Medical Oncology ProgramRuth and Donald Goodman Endowed Chair in GI OncologyProfessor of Medicine, Senior Attending PhysicianUniversity Hospitals Siedman Cancer CenterCase Comprehensive Cancer CenterCase Western Reserve UniversityCleveland, OhioShubham Pant, MDProfessorDepartment of Gastrointestinal (GI) Medical OncologyDepartment of Investigational Cancer TherapeuticsDirector of Clinical ResearchAssociate Director for Early Phase Drug DevelopmentSheikh Ahmed Bin Zayed Al Nahyan CenterMD Anderson Cancer CenterHouston, TexasLink to full program:https://bit.ly/3KL2ank Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Treatment Advances in Gastroesophageal Cancers with guest Dr. Raghav Sundar September 21, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Treatment Advances in Gastroesophageal Cancers with guest Dr. Raghav Sundar September 21, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Dr. Dipti Sagar discusses Gastroesophageal Reflux with Dr. Ben Weitz. [If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]   Podcast Highlights         ____________________________________________________________________ Dr. Dipti Sagar is an Integrative Gastroenterologist who practices in Century City as an associate of Dr. Farshid Rahbar and reflux is one of the many GI conditions that she treats regularly in patients. Her website is LAIntegrativeGI.com. Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

How confident are you navigating biomarker conversations with your gastric cancer patients? Credit available for this activity expires: 8/19/2026 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1002840?ecd=bdc_podcast_libsyn_mscpedu

Featuring perspectives from Dr Geoffrey Y Ku and Dr Zev Wainberg, including the following topics: Introduction: ASCO Preview (0:00) HER2-Positive Gastroesophageal Cancers (19:03) Immunotherapy in HER2-Negative Advanced Gastroesophageal Cancers (36:11) Immunotherapy in Microsatellite Instability-High Gastroesophageal Cancers (44:04) CLDN18.2-Positive Advanced Gastroesophageal Cancers (51:30) CME information and select publications

Dr Geoffrey Y Ku from the Memorial Sloan Kettering Cancer Center in New York, New York, and Dr Zev Wainberg from the UCLA School of Medicine discuss patient cases and summarize current treatment approaches for gastroesophageal cancer. CME information and select publications here.

Dr Geoffrey Y Ku from the Memorial Sloan Kettering Cancer Center in New York, New York, and Dr Zev Wainberg from the UCLA School of Medicine discuss patient cases and summarize current treatment approaches for gastroesophageal cancer. CME information and select publications here.

Dr Sunnie Kim and Dr Manish Shah summarize the clinical treatment landscape for patients with gastroesophageal cancers, supported by clinical perspectives and management strategies from oncology nursing experts Ms Brooke Parker and Ms Michal Segal. NCPD information and select publications here.

Dr Sunnie Kim and Dr Manish Shah summarize the clinical treatment landscape for patients with gastroesophageal cancers, supported by clinical perspectives and management strategies from oncology nursing experts Ms Brooke Parker and Ms Michal Segal. NCPD information and select publications here.

Featuring perspectives from Dr Sunnie Kim, Ms Brooke Parker, Ms Michal Segal and Dr Manish Shah, including the following topics: Introduction: Clinical Presentation of Gastroesophageal Cancer (0:00) Management of Localized or Locally Advanced Gastroesophageal Cancers; Current and Future Role of Immune Checkpoint Inhibitors (21:44) Incorporation of Immunotherapeutic Strategies for HER2-Negative Metastatic Gastroesophageal Tumors (39:32) Role of Therapy Targeting CLDN18.2 in Advanced Gastric/Gastroesophageal Junction Adenocarcinoma (1:00:50) Considerations in the Care of Patients with HER2-Positive Gastroesophageal Cancers (1:22:41) NCPD information and select publications

Dr. Mindy answers questions about losing your voice, is it cold or is it allergies, toe fungus, Diabetic ketoacidosis, mouth taping, fused vertebrae, gout, decongestions during breast feeding, the Dr. Mindy Experiment, direct primary care, broken big toe, PCOS fertility naturally, carpal tunnel, genetic testing results, mounjaro, Gastroesophageal reflux disease, sitting on your hands and truck driver physicals. https://www.youtube.com/@TheDrMindyExperimentSee omnystudio.com/listener for privacy information.

Featuring perspectives from Dr Yelena Y Janjigian and Dr Samuel J Klempner, MD, including the following topics: Role of Immune Checkpoint Inhibitors in the Management of Gastroesophageal Cancers — Dr Janjigian (0:00) Available and Emerging Targeted Therapeutic Approaches for Gastroesophageal Cancers — Dr Klempner(28:38) CME information and select publications

Clinical investigators discuss available data guiding the management of gastroesophageal cancer.  CME information and select publications here.

Clinical investigators discuss available data guiding the management of gastroesophageal cancer.  CME information and select publications here.