Join moderator Caroline DiCristo, PharmD, Associate Medical Director – Zanidatamab of Jazz Pharmaceuticals, alongside Dr. Noman Ashraf, MD, of Tampa General Hospital Cancer Institute for the final installment of the Advancing Care in GI and Biliary Tract Cancers podcast series. This episode focuses on gastroesophageal adenocarcinoma (GEA), exploring the disease state, patient management strategies, and the critical role of the multidisciplinary team (MDT) in delivering comprehensive, high-quality care. Gastroesophageal adenocarcinoma represents a complex and evolving disease spectrum, encompassing malignancies of the esophagus, gastroesophageal junction, and stomach. With rising incidence rates, particularly in Western populations, clinicians are increasingly faced with challenges related to delayed diagnosis, heterogeneous disease biology, and the need for coordinated, team-based care. Understanding GEA Disease Presentation and Risk Factors The discussion begins with a foundational overview of GEA, including its epidemiology and key risk factors. While historically associated with smoking and alcohol use in squamous cell carcinoma, the rise in adenocarcinoma is closely linked to obesity, gastroesophageal reflux disease (GERD), and Barrett’s esophagus. Patients often present with non-specific or late-stage symptoms, such as dysphagia, weight loss, or anemia, contributing to delayed diagnosis and more advanced disease at presentation. The Importance of Multidisciplinary Care A central theme of the episode is the essential role of the multidisciplinary team in both diagnosis and treatment planning. From gastroenterologists performing endoscopic evaluation and biopsy, to pathologists guiding biomarker testing, and oncologists, surgeons, and radiation specialists determining treatment strategy, effective collaboration is critical. Additional support from dietitians, rehabilitation specialists, and speech therapists further underscores the complexity of managing GEA and optimizing patient outcomes. Diagnostic Workup and Staging The episode outlines the stepwise approach to confirming a diagnosis and staging disease, including endoscopy with biopsy, imaging with CT and PET scans, and endoscopic ultrasound (EUS) for local staging. Accurate staging is emphasized as the most important prognostic factor and a key determinant in guiding treatment decisions. Biomarker-Driven Treatment in Advanced Disease In the metastatic setting, treatment has become increasingly personalized, driven by biomarker testing. The discussion highlights the importance of assessing MSI status, HER2 expression, PD-L1 status, and Claudin 18.2 to inform therapy selection. Advances in immunotherapy and targeted treatments have significantly expanded options beyond traditional chemotherapy, allowing for more tailored and effective approaches based on individual tumor biology. Emerging Therapies and Evolving Landscape The episode also explores the rapidly evolving treatment landscape, including promising data from recent clinical trials evaluating HER2-targeted therapies such as zanidatamab. These emerging approaches may reshape standard of care and improve outcomes for patients. Patient-Centered, Team-Based Decision Making Through clinical insights and real-world perspectives, Dr. Ashraf emphasizes the importance of aligning treatment decisions with patient needs, preferences, and overall health status. Shared decision-making, supported by a coordinated care team, remains essential in navigating the complexities of GEA management. Tune in for a comprehensive discussion on gastroesophageal adenocarcinoma and how multidisciplinary collaboration, biomarker-driven care, and emerging therapies are shaping the future of treatment in GI cancers.
