Dr. Catenacci on Treatment Selection in Esophagogastric Junction Adenocarcinoma

Daniel Catenacci, MD, associate professor of medicine, gastrointestinal medical oncologist, director, Gastrointestinal Oncology Program, and assistant director of translational research, Comprehensive Cancer Center, University of Chicago Medicine, discusses factors that may guide treatment selection for patients with esophagogastric junction adenocarcinoma.

Patient characteristics such as burden of disease, symptoms, and performance status may influence treatment decisions in this space, says Catenacci. Tumor biology should also be factored into the equation albeit with the understanding that testing for targetable biomarkers may delay the start of treatment by up to 5 weeks.

Although chemotherapy should be considered up front for patients who require immediate intervention, these factors can help sequence immunotherapy, explains Catenacci.

For example, patients with microsatellite instability­—high disease who may progress quickly on first- or second-line treatment should receive immunotherapy as early as possible to derive the greatest benefit. Conversely, if immunotherapy is being considered in patients who are PD-L1–negative, Catenacci does not recommend using a monotherapy checkpoint blockade, unless it’s in the context of a clinical trial.

Patients with low PD-L1 expression may benefit from immunotherapy if they have good performance status, low burden of disease, and do not require immediate response, says Catenacci. Patients who do not fit into those categories are better served by chemotherapy, he concludes.