Dr. Mamdani on the Need for Novel Therapies in Locally Advanced Esophageal/GEJ Adenocarcinoma

Hirva Mamdani, MD
Published: Tuesday, Apr 28, 2020



Hirva Mamdani, MD, assistant professor of medicine, Department of Oncology, Barbara Ann Karmanos Cancer Institute, discusses the need to develop novel therapies in locally advanced esophageal and gastroesophageal junction (GEJ) adenocarcinoma.

The incidence of esophageal and GEJ adenocarcinoma is a rising in the United States, says Mamdani. Additionally, most patients present with locally advanced disease.

Patients who are medically fit may receive concurrent chemoradiation in the neoadjuvant setting followed by surgery, explains Mamdani. However, about half of these patients will experience disease relapse within a year after treatment. Moreover, patients who do not achieve a pathologic complete response to neoadjuvant therapy or those who have persistent disease in the lymph nodes are more likely to relapse.

Currently, adjuvant therapies have not demonstrated a survival benefit in this patient population. Therefore, developing novel strategies is critical, says Mamdani.

PD-1/PD-L1 is often upregulated in response to chemotherapy and radiation. As such, immune checkpoint inhibitors such as durvalumab (Imfinzi) could be a potential treatment approach after trimodality therapy in patients with locally advanced esophageal and GEJ adenocarcinoma, concludes Mamdani.
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Hirva Mamdani, MD, assistant professor of medicine, Department of Oncology, Barbara Ann Karmanos Cancer Institute, discusses the need to develop novel therapies in locally advanced esophageal and gastroesophageal junction (GEJ) adenocarcinoma.

The incidence of esophageal and GEJ adenocarcinoma is a rising in the United States, says Mamdani. Additionally, most patients present with locally advanced disease.

Patients who are medically fit may receive concurrent chemoradiation in the neoadjuvant setting followed by surgery, explains Mamdani. However, about half of these patients will experience disease relapse within a year after treatment. Moreover, patients who do not achieve a pathologic complete response to neoadjuvant therapy or those who have persistent disease in the lymph nodes are more likely to relapse.

Currently, adjuvant therapies have not demonstrated a survival benefit in this patient population. Therefore, developing novel strategies is critical, says Mamdani.

PD-1/PD-L1 is often upregulated in response to chemotherapy and radiation. As such, immune checkpoint inhibitors such as durvalumab (Imfinzi) could be a potential treatment approach after trimodality therapy in patients with locally advanced esophageal and GEJ adenocarcinoma, concludes Mamdani.

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