Ep. 64 Evolving Perioperative Management Strategies for Gastric & GE Junction Cancers with Dr. Michael Gibson

Is personalized, surgery-sparing treatment becoming a reality for patients with gastric adenocarcinoma? In this episode of BackTable Tumor Board, Dr. Eric Lander and Dr. Michael Gibson break down the rapidly changing landscape of treatment for resectable gastric and gastroesophageal junction adenocarcinoma. They trace the evolution from surgery as the standard, through difficult postoperative chemoradiation and perioperative chemotherapy (MAGIC, FLOT4), to the new strategies that are moving beyond traditional chemoradiation in the wake of the ESOPEC trial.

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This podcast is supported by

AstraZeneca
https://www.astrazeneca.com/our-therapy-areas/oncology/gastrointestinal-cancer.html

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Timestamps

00:00 - Introduction
09:41 - FLOT Becomes Standard
19:54 - Keynote 585 and Matterhorn
28:35 - Managing DFL Toxicity
35:10 - Path CR and Deescalation
38:46 - Future Directions and Organ Preservation

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More about this episode

The conversation highlights the Matterhorn trial’s positive results with durvalumab added to perioperative FLOT, including manageable toxicity and benefits seen across PD-L1 expression levels. Lander and Gibson share practical management tips for patients who cannot tolerate FLOT, staging nuances like selective diagnostic laparoscopy, and future directions such as targeted therapy combinations, total neoadjuvant approaches, ctDNA-guided de-escalation, and organ preservation for MSI-high disease.

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Resources

Matterhorn Trial
https://www.nejm.org/doi/abs/10.1056/NEJMoa2503701

ESOPEC Study
https://www.nejm.org/doi/abs/10.1056/NEJMoa2409408

CheckMate 577
https://www.nejm.org/doi/full/10.1056/NEJMoa2032125

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