Updates in the Multidisciplinary Approach for Resectable Gastroesophageal Adenocarcinoma and Peritoneal-Limited Disease

Presented by:
Travis E. Grotz
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and
Harry H. Yoon
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Volume/Issue:
Volume 23: Issue Supplement
Online Publication Date:
27 May 2025
DOI:
https://doi.org/10.6004/jnccn.2025.5011
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The management of gastroesophageal adenocarcinoma requires a nuanced, multidisciplinary approach. For resectable disease, perioperative FLOT is the newly preferred standard based on results from the ESOPEC trial, but careful patient selection and consideration of alternatives such as chemoradiotherapy remain crucial. Immunotherapy is transforming the treatment of mismatch repair–deficient tumors. For peritoneal-limited disease, systemic therapy remains the foundation of treatment. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is now included in the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers as an option for highly selected patients treated at experienced centers who are capable of achieving complete cytoreduction following a good response to chemotherapy. Bidirectional intraperitoneal therapy is a promising investigational approach currently under active study. Ongoing trials continue to refine patient selection and treatment strategies across these complex clinical scenarios.

Disclosures: Dr. Yoon has disclosed receiving grant/research support from Amgen Inc., BeiGene, Ltd., Bristol Myers Squibb, Merck & Co., Inc., AstraZeneca, and Daiichi Sankyo. Dr. Grotz has disclosed no relevant financial relationships.

Correspondence: Travis E. Grotz, MD, Mayo Clinic Comprehensive Cancer Center, 200 1st Street SW, Rochester, MN 55905. Email: grotz.travis@mayo.edu; and
Harry H. Yoon, MD, Mayo Clinic Comprehensive Cancer Center, 200 1st Street SW, Rochester, MN 55905. Email: yoon.harry@mayo.edu
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
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  • 1.

    Ajani JA, D’Amico TA, Bentrem DJ, et al. NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. Version 2.2025. Accessed April 2, 2025. To view the most recent version, visit https://www.nccn.org

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074–2084.

  • 3.

    Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med 2021;384:1191–1203.

  • 4.

    Hoeppner J, Brunner T, Schmoor C, et al. Perioperative chemotherapy or preoperative chemoradiotherapy in esophageal cancer. N Engl J Med 2025;392:323–335.

  • 5.

    Eads JR, Graham N, Gibson MK, et al. A phase II/III study of peri-operative nivolumab (nivo) and ipilimumab (ipi) in patients (pts) with locoregional esophageal (E) and gastroesophageal junction (GEJ) adenocarcinoma: results of the neoadjuvant pathologic complete response (pCR) rate (ECOG-ACRIN EA2174). J Clin Oncol 2024;42(Suppl):Abstract 4000.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet 2021;398:27–40.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Al-Batran SE, Homann N, Pauligk C, et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 trial. JAMA Oncol 2017;3:1237–1244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol 2011;18:1575–1581.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Rau B, Lang H, Koenigsrainer A, et al. Effect of hyperthermic intraperitoneal chemotherapy on cytoreductive surgery in gastric cancer with synchronous peritoneal metastases: the phase III GASTRIPEC-I trial. J Clin Oncol 2024;42:146–156.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Green BL, Blumenthaler AN, Gamble LA, et al. Cytoreduction and HIPEC for gastric carcinomatosis: multi-institutional analysis of two phase II clinical trials. Ann Surg Oncol 2023;30:1852–1860.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Buckarma E, Thiels CA, Jin Z, Grotz TE. Cytoreduction and hyperthermic intraperitoneal paclitaxel and cisplatin for gastric cancer with peritoneal metastasis. Ann Surg Oncol 2024;31:622–629.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Ji ZH, Yu Y, Liu G, et al. Peritoneal cancer index (PCI) based patient selecting strategy for complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in gastric cancer with peritoneal metastasis: a single-center retrospective analysis of 125 patients. Eur J Surg Oncol 2021;47:1411–1419.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ishigami H, Fujiwara Y, Fukushima R, et al. Phase III trial comparing intraperitoneal and intravenous paclitaxel plus S-1 versus cisplatin plus S-1 in patients with gastric cancer with peritoneal metastasis: PHOENIX-GC trial. J Clin Oncol 2018;36:1922–1929.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Yan C, Yang Z, Shi Z, et al. Intraperitoneal and intravenous paclitaxel plus S-1 versus intravenous paclitaxel plus S-1 in gastric cancer patients with peritoneal metastasis: results from the multicenter, randomized, phase 3 DRAGON-01 trial. Presented at the 2025 ASCO Gastrointestinal Cancers Symposium; January 23–25, 2025; San Francisco, California. Abstract 327.

    • PubMed
    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2025 by the National Comprehensive Cancer Network 2025
Article Category:
Abstract
Print Publication Date:
01 May 2025
Online Publication Date:
27 May 2025

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