Get the inside scoop on major immunotherapy breakthroughs in esophageal and gastroesophageal junction (GEJ) cancers. Drs. Ronan J. Kelly (Medical Oncologist, Baylor University Medical Center) and Jacob Kettle (Pharmacist, University of Missouri) discuss recent practice-changing clinical trials, new drug approvals, and their application in practice. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us (Air date: 4/21/2021)   TRANSCRIPT [MUSIC PLAYING]   ANNOUNCER: The purpose of this podcast is to educate and inform. This is not a substitute for 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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING]   JACOB KETTLE: Welcome to the ASCO e-learning podcast episode focusing on immunotherapy for esophageal and gastroesophageal junction cancer. My name is Dr. Jacob Kettle. I'm an oncology clinical pharmacy specialist and pharmacy manager at the University of Missouri Health Care's Fischel Cancer Center. Today, I'm joined by medical oncologist, Dr. Ronan Kelly. Dr. Kelly is the director of oncology at the Charles A. Sammons Cancer Center and the WW Caruth junior chair in immunology at Baylor University Medical Center in Dallas. We have a lot of great content to explore today, so really, some things that are truly practice-changing. But to facilitate learning, let's start with a brief patient case. SB is a 64-year-old male who initially presented to his primary care physician with a two month history of dysphagia with solids, unintentional weight loss of 25 pounds, and fatigue. Endoscopy revealed a tumor in the distant third of the esophagus and pathology confirmed an invasive moderately differentiated adenocarcinoma. Preoperative workup patient was stage II. Following chemotherapy and radiation, esophagectomy demonstrated 5 of 20 lymph nodes positive. So while we're going to focus predominantly today on the role of adjuvant therapy with immunotherapy treatments in esophageal and GE junction tumors, to truly appreciate these advancements, I think it first requires understanding the challenges of the disease state. So Dr. Kelly, would you mind summarizing the historical treatment landscape and how there's been such substantial unmet needs in this patient population? RONAN KELLY: Sure. And thank you, Dr. Kettle, and thank you to the ASCO team for the invitation to participate in this podcast today. If we look at esophageal and gastroesophageal junction cancers, there really hasn't been that many breakthroughs in recent years. We've really been relying on two major ways to treat stage II and stage III disease. And we're going to talk about operable disease for the first part of this podcast. At the present time, the standard of care had been either chemoradiation with the cross regimen, which was published by van Hagen and Allen in 2012, so almost 10 years ago now. And there has been concern about the use of low dose chemotherapy with that regimen. People have wondered about the need for really systemic doses of chemotherapy. It's very well-tolerated, but again, the concern was, are we minimizing the systemic treatments using chemoradiation? However, that really had been the favored regimen for many years. In the last couple of years, we've probably seen people moving away from low dose carboplatin/paclitaxel into more of a FOLFOX type regimen with radiation, and then having the surgery. The other way to do this is perioperative chemotherapy, which really, the current standard had been the FLOT4 regimen. This was a regimen that emerged from Germany, published in 2019, using chemotherapy for four cycles before surgery and four cycles after surgery. There is a challenge there, however. The FLOT regimen is mostly, if you look at the study de