This document summarizes several landmark trials investigating chemotherapy and radiation therapy approaches for gastric cancer. Key points include:
- Perioperative chemotherapy is now standard for resectable stage II-IV gastric cancer based on trials like MAGIC and FLOT4 showing improved survival.
- FLOT4 established docetaxel-based chemotherapy as the preferred perioperative regimen.
- Adjuvant chemotherapy is recommended after curative surgery without neoadjuvant therapy based on the CLASSIC trial.
- Trials like ARTIST1/2 and CALGB80101 found no benefit to adding adjuvant radiation after D2 lymph node dissection.
- Targeted agents like trastuzumab and ramuc
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
Poly-ADP-ribose polymerase inhibitors (PARPis) are the most active and interesting therapies approved for the treatment of epithelial ovarian cancer. They have changed the clinical management of a disease characterized, in almost half of cases, by extreme genetic complexity and alteration of DNA damage repair pathways, particularly homologous recombination (HR) deficiency. It is causing a paradigm shift in the first-line treatment of patients with advanced ovarian cancer
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
Poly-ADP-ribose polymerase inhibitors (PARPis) are the most active and interesting therapies approved for the treatment of epithelial ovarian cancer. They have changed the clinical management of a disease characterized, in almost half of cases, by extreme genetic complexity and alteration of DNA damage repair pathways, particularly homologous recombination (HR) deficiency. It is causing a paradigm shift in the first-line treatment of patients with advanced ovarian cancer
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
Management of locally advanced ovarian, fallopian tube, and peritoneal tumors requires a comprehensive and multidisciplinary approach. Locally advanced tumors are those that have spread beyond the ovaries or fallopian tubes and may involve nearby structures, such as the peritoneum or adjacent organs. Here's a brief overview of the management strategies:
Surgery:
Debulking Surgery: The primary treatment for locally advanced tumors involves cytoreductive or debulking surgery. This aims to remove as much of the tumor as possible. Surgeons may perform a total hysterectomy, bilateral salpingo-oophorectomy, and removal of involved peritoneal tissues.
Lymphadenectomy: Lymph node dissection is often done to assess the extent of the disease spread and to remove involved lymph nodes.
Chemotherapy:
Neoadjuvant Chemotherapy: In some cases, chemotherapy may be administered before surgery to shrink the tumor, making surgery more effective.
Adjuvant Chemotherapy: Following surgery, chemotherapy is typically recommended to target any remaining cancer cells. Platinum-based chemotherapy regimens are commonly used.
Targeted Therapies:
PARP Inhibitors: Poly (ADP-ribose) polymerase inhibitors, such as olaparib and niraparib, have shown efficacy in treating ovarian and related cancers with specific genetic mutations, like BRCA mutations.
Immunotherapy:
Checkpoints Inhibitors: Immune checkpoint inhibitors, like pembrolizumab and nivolumab, may be considered in cases with specific molecular profiles.
Radiation Therapy:
External Beam Radiation: In some situations, radiation therapy may be used to target specific areas affected by the tumor.
Clinical Trials:
Participation in clinical trials may be an option for patients with locally advanced disease, offering access to innovative treatments and therapies.
Follow-up Care:
Regular monitoring and follow-up care are crucial to assess treatment effectiveness and detect any signs of recurrence.
Palliative Care:
Palliative care should be integrated into the management plan to address symptom control, improve quality of life, and provide support for both the patient and their family.
A personalized treatment plan should be developed based on the specific characteristics of the tumor, the patient's overall health, and individual factors. Regular communication among a multidisciplinary team, including surgeons, medical oncologists, radiation oncologists, and other specialists, is essential for optimizing the management of locally advanced ovarian, fallopian tube, and peritoneal tumors.
How the role of radiotherapy has evaluated in pancreatic cancer. Now it has become indispensable for treatment in pancreatic cancer. Radiotherapy can be used in the form of EBRT/SBRT/IORT.
Cette présentation faite le 27 Avril 2017 à l'Hôpital Saint Joseph organisée par le Dr Vincent de Parades fait le point sur les nouvelles approches multidisciplinaires dans la prise en charge des cancers colorectaux en insistant sur la prise en charge de la maladie métastatique hépatique et de la carcinome péritonéale pour terminer sur les nouvelles approches par immunothérapie. Cette EPU a connu un large succès d'audience avec plus de 60 participants. Merci à toutes et tous.
Similar to LANDMARK CHEMOTHERAPY AND RADIATION TRIALS IN GASTRIC CANCER.pptx (20)
A concise presentation on etiopathogenesis of head and neck cancer, oral potentially malignant disorders and role of epigenetics in head and neck cancer.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
5. • Stage II to IV adenocarcinoma of stomach, GEJ and lower third esophagus
• N= 253
• Radical resection of
primary and nodes
Surgery alone
• N=250
• 3 cycles ECF before and
after surgery
Perioperative
chemotherapy
Prof. S. Subbiah et al
6. • Increasing the likelihood of curative resection by downstaging
the tumor
• eliminating micrometastases
• rapidly improving tumor-related symptoms
• determining whether the tumor is sensitive to the
chemotherapy
Prof. S. Subbiah et al
7. • 229 pts (91.6%) underwent surgery
• 104 out of 250 (41%) completed peri operative chemotherapy
Prof. S. Subbiah et al
9. • 50% patients in MAGIC trial didn’t complete post operative chemotherapy
• T3- T4
• N=144
• NACT+ surgery (72) vs surgery (72)
• 2 cycles of 48 days
– Cisplatin 50mg/m2 IV on days 1, 15 & 29
– Leucovorin 500mg/m2 IV over 2 hours
– 5 FU 2g/m2 continuous IVI days – 1,8,15,22,29 & 36
Prof. S. Subbiah et al
11. • Number of D2 gastrectomies were almost equal – 96% vs 92%
• Inadequate statistical power to detect potential survival difference
• Better surgical resection might have compensated for the benefits offered
by neoadjuvant chemotherapy
Prof. S. Subbiah et al
12. 2-3 pre operative chemo 4 weekly
cisplatin 100 mg/m2 IV day 1
5 FU 800mg/m2 CIVI day 1-5
Prof. S. Subbiah et al
14. • Docetaxel had shown benefit in metastatic gastric and GEJ tumors
• 28 German centres
• N= 716
• FLOT 4 (356) vs ECF (360)
FLOT 4 every 2 weeks ECF/ECX every 3 weeks
Docetaxel 50 mg/m2 IV day 1 Epirubicin 50 mg/m2 IV day 1
Oxaliplatin 85mg/m2 IV day 1 Cisplatin 60 mg/m2 IV day 1
LV 200mg/m2 IV day 1 5 FU – 200 mg/m2 CIVI day 1
5 FU – 2600mg/m2 IV day 1 Capecitabine 1250 mg/m2 PO day 1 - 21
Prof. S. Subbiah et al
16. FLOT ECF/ECX P
3 year OS 57% 48% 0.012
Median DFS 30 months 18 months 0.0036
Serious adverse
events
27% 27% NS
R0 resection 85% 78% 0.012
Post op complications 51% 50% NS
In locally advanced resectable gastric and GEJ adenocarcinoma,
peri operative FLOT improved OS when compared to peri operative
ECF/ECX
Prof. S. Subbiah et al
17. PERIOPERATIVE CHEMOTHERAPY TRIALS
• T2 N0 and above – peri operative chemotherapy is the
standard of care ( MAGIC, EORTC 40954, ACCORD 07 )
• FLOT 4 is the standard regimen at present ( FLOT 4 )
• Poor PS or multiple co morbidities – FOLFOX or CAPOX
Prof. S. Subbiah et al
18. •Peri operative chemotherapy has shown improved overall survival
in patients with resectable gastric cancer
•Can addition of radiation in peri operative setting improve
outcomes?
Prof. S. Subbiah et al
19. • Stage IB – IVA adenocarcinoma of stomach and GEJ ( siewert II – III)
• N= 788
Curative
surgery (310)
3 cycles post op
chemo (180)
ECX/EOX
3 cycles
21 days
3 cycles chemo –
curative surgery(342)
RT 45 gy + capecitabine
575mg/m2 BD on days
of RT + weekly CDDP 20
mg/m2 (188)
CTRT
Prof. S. Subbiah et al
20. Periop chemo Periop CTRT P
Median OS 43 months 37months 0.9
Median EFS 28 months 25 months 0.92
Prof. S. Subbiah et al
28. • To evaluate the effect of adjuvant chemotherapy with capecitabine and oxaliplatin
after D2 gastrectomy
• Curative gastrectomy with atleast 15 nodes
N=1035
Surgery alone
n= 515
Surgery f/b adjuvant
chemotherapy
n = 520
•3 weekly cycle of capecitabine 1000mg/m2
BD days 1 – 14
•Oxaliplatin 130 mg/m2 IV day 1
•6 months
•67% pts completed the course
•90% needed dose modification
Prof. S. Subbiah et al
29. Adjuvant treatment with capecitabine and oxaliplatin should be
considered after D2 gastrectomy
Prof. S. Subbiah et al
30. Addition of docetaxel to S-1 is effective with few
safety concerns in stage III gastric cancer
Prof. S. Subbiah et al
31. • Addition of radiation to adjuvant
chemotherapy after D2 gastrectomy
Prof. S. Subbiah et al
32. • Stage Ib – IV adenocarcinoma with R0 resection of primary with D2
lymphadenectomy
N=458
N=228
Capecitabine
1000mg/m2 BD day 1-
14 + cisplatin 60mg/m2
day 1 – 3 weekly 6 cycles
N = 230
2 cycles XP + EBRT 45
Gy/25# with
capecitabine 825mg/m2
BD all days + 2 more
cycles XP 3 weekly
Prof. S. Subbiah et al
33. XP XP/XRT
No benefit of post operative
chemoradiation over adjuvant chemo
after D2 dissection
Prof. S. Subbiah et al
35. CALGB
N=546
N=280
5 FU/LV x 1
5 FU CIVI + RT
5 FU/LV x 2
N= 266
ECF x 1
5 FU CIVI + RT
ECF x 2
5 FU 425 mg/m2/day IV day 1-5
LV 20mg/m2/day IV day 1-5
RT – 45Gy/25# + 5 FU 200 mg/m2/day
CIVI
ECF – epirubicin 50 mg/m2 IV day1
Cisplatin 60 mg/m2 IV day 1
5 FU 200mg/m2/day D 1 - 21
Prof. S. Subbiah et al
36. Following a curative resection of GEJ and gastric adenocarcinoma, post op
CTRT with ECF doesn’t improve survival when compared to bolus 5 FU/LV
Prof. S. Subbiah et al
37. ADJUVANT TRIALS
• After a potentially curative surgery without any neo adjuvant therapy, adjuvant
chemotherapy is recommended - >T2 , N+ ( CLASSIC )
• After D2 dissection, there is no benefit of adjuvant radiation ( ARTIST 1 & 2, CALGB
80101)
• Less than D2 dissection or < 16 nodes dissected – adjuvant chemoradiation is
preferred ( INT 0116)
• S 1 is the standard of care in Japan
• CAPOX is the preferred regimen
– 8 cycles 3 weekly
– Capecitabine 1000mg/m2 PO BD days 1 to 14
– Oxaliplatin 130mg/m2 IV day 1
Prof. S. Subbiah et al
39. ToGA
Post hoc – better OS
with IHC 2+ and FISH +
or IHC 3+
Median follow up was
19 and 17 months
HER 2 overexpression
positive, locally
advanced, recurrent,
metastatic GC or EGJ
N= 594
Trastuzumab +
cisplatin & 5FU/
capecitabine
OS -13.8 months
Chemotherapy
alone
OS -11 months
Prof. S. Subbiah et al
40. • HERXO – Trastuzumab + oxaliplatin + 5FU/ capecitabine
• DESTINY gastric 01 – Fam trastuzumab deruxtecan nxki +
chemo as second line chemotherapy after failure of prior two
lines even with trastuzumab
Prof. S. Subbiah et al
41. • Ramucirumab – VEGFR 2 antibody for progressive disease
– REGARD – median OS improved by 1.4 months
– RAINBOW – paclitaxel + ramucirumab. Median OS 9.6 vs 7.3 months.
Better PFS
– RAINFALL – does not reduce disease progression in treatment naïve
patients
Ramucirumab + paclitaxel as second line therapy in progressive disease
Prof. S. Subbiah et al
42. • Nivolumab – monoclonal PD 1 antibody
– CHECKMATE – 649 : HER 2 negative, unresectable
nivolumab + chemotherapy ( CAPOX or FOLFOX)
Better OS and PFS
Nivolumab + 5 FU/ capecitabine + oxaliplatin as first line treatment
option in HER 2 negative tumours with PD L1 expression levels by CPS
>5
Prof. S. Subbiah et al
43. • Pembrolizumab – PD 1 antibody
– KEYNOTE 158 – tumors identified with TMB – H had an ORR of 29%
and complete response rate in 4%
Pembrolizumab in second line or subsequent treatment of MSI- H/dMMR
or TMB- H tumors
Prof. S. Subbiah et al
44. • Dostarlimab – gxly – anti PD 1 antibody
– GARNET – dMMR solid tumors ( endometrial / GI) ORR 42% and
complete response 5%
median duration of response 35 months
Progressive tumors who have not received PD 1, PD L 1 or CTLA 4
inhibitors as second line therapy
Prof. S. Subbiah et al
45. • Entrectinib and Larotrectinib
– NTRK fusion gene inhibitors
– LOXO – TRK – 14001, SCOUT, NAVIGATE
– ORR across 3 trials – 75% and complete response rate 22%
– STARTRK – 2 : ORR 57%, CR 7%
Second line or subsequent treatment options in NTRK gene fusion
positive gastric tumors
Prof. S. Subbiah et al
46. Conversion gastrectomy
surgical treatment aiming at R0 resection for tumors that were deemed
unresectable before chemotherapy.
operitoneal cancer index (PCI)> 6
obilobar hepatic metastases
onodal involvement outside D1-3 stations
otechnically unresectable metastases
Prof. S. Subbiah et al
47. R0 conversion surgery was associated with a significantly longer PFS than R1 resections
More than one type of metastasis significantly affect prognosis
Prof. S. Subbiah et al