13 Oct 2026
Ep. 85 Perioperative Management in Upper GI Cancers with Dr. Dani Castillo and Dr. Alexandra Gangi
How do you choose between perioperative chemotherapy and trimodality therapy for a patient with localized upper GI cancer, and what has the newest data actually settled? On this episode of BackTable Tumor Board, host Dr. Kate Baker interviews Dr. Dani Castillo, a medical oncologist at City of Hope in Duarte, California, and Dr. Alexandra Gangi, a gastrointestinal surgical oncologist at Cedars-Sinai in Los Angeles, about everything that happens between a new diagnosis and a resection in localized esophageal, gastroesophageal junction and gastric cancer. They cover diagnostic workup, Siewert classification, staging laparoscopy, histology, biomarker testing, surgical candidacy, and the challenges of nutrition and prehabilitation.
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Timestamps
00:00 - Introduction01:42 - Diagnostic Workup and Siewert Classification04:20 - Histology, Risk Stratification, and Biomarkers07:03 - Surgical Candidacy and Preoperative Optimization10:26 - Perioperative Chemotherapy versus Trimodality Therapy13:37 - Chemotherapy Tolerability, Immunotherapy, and Dose Reduction15:10 - Gastrectomy, Esophagectomy, and Recovery20:05 - Pathologic Response and Adjuvant Decisions21:55 - Organ Preservation and ctDNA24:54 - Future Directions and Ongoing Trials26:35 - Multidisciplinary Care and Community Practice27:40 - Closing Remarks
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More about this episode
The conversation tackles the choice between perioperative chemotherapy and chemoradiation, when to add immunotherapy, and the latest data from ESOPEC and MATTERHORN. Dr. Gangi explains why subtotal versus total gastrectomy, anastomotic technique, and node dissection matter for recovery. The team discusses the role of organ preservation, ctDNA for de-escalation, and why multidisciplinary care remains essential even in smaller community practices. The episode closes with real-world strategies for managing frailty, dose reduction, and ensuring patients and providers are aligned before heading to the OR and why upper GI cancer stays a multidisciplinary disease even where the team is small.
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Resources
Hoeppner J, et al. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer (ESOPEC). N Engl J Med. 2025https://pubmed.ncbi.nlm.nih.gov/39842010/ ESOPEC trial registry record (NCT02509286)https://clinicaltrials.gov/study/NCT02509286 Al-Batran SE, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin (FLOT4). Lancet. 2019https://pubmed.ncbi.nlm.nih.gov/30982686/ Perioperative durvalumab plus fluorouracil, leucovorin, oxaliplatin and docetaxel for resectable gastric and gastro-oesophageal junction adenocarcinoma (MATTERHORN). Lancet. 2026https://pubmed.ncbi.nlm.nih.gov/42716074/ MATTERHORN trial registry record (NCT04592913)https://clinicaltrials.gov/study/NCT04592913 Pembrolizumab Plus Chemotherapy Versus Chemotherapy as Perioperative Therapy in Locally Advanced Gastric and Gastroesophageal Junction Cancer: Final Analysis of KEYNOTE-585. J Clin Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/40829093/ KEYNOTE-585 trial registry record (NCT03221426)https://clinicaltrials.gov/study/NCT03221426 Goodman KA, et al. Randomized Phase II Study of PET Response-Adapted Combined Modality Therapy for Esophageal Cancer: Mature Results of the CALGB 80803 (Alliance) Trial. J Clin Oncol. 2021https://pubmed.ncbi.nlm.nih.gov/34077237/ CALGB 80803 trial registry record (NCT01333033)https://clinicaltrials.gov/study/NCT01333033 Kelly RJ, et al. Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer (CheckMate 577). N Engl J Med. 2021https://pubmed.ncbi.nlm.nih.gov/33789008/ Cunningham D, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer (MAGIC). N Engl J Med. 2006https://pubmed.ncbi.nlm.nih.gov/16822992/ NCCN Guidelines Insights: Esophageal and Esophagogastric Junction Cancers, Version 4.2026. J Natl Compr Canc Netw. 2026https://pubmed.ncbi.nlm.nih.gov/42753809/ NCCN Clinical Practice Guidelines in Oncology, treatment by cancer typehttps://www.nccn.org/guidelines/category_1 Genomics of gastroesophageal junction adenocarcinomas and the Siewert classification. Transl Gastroenterol Hepatol. 2026https://pubmed.ncbi.nlm.nih.gov/42291157/ Dr. Dani Castillo, medical oncology, City of Hopehttps://www.cancercenter.com/physician-directory/dani-castillo Dr. Alexandra Gangi, Cedars-Sinai faculty profilehttps://researchers.cedars-sinai.edu/Alexandra.Gangi Dr. Alexandra Gangi, NANETS Board of Directors profilehttps://nanets.net/about/board-of-directors/450-gangi Dr. Kate Baker, BackTable contributor pagehttps://www.backtable.com/shows/tumor-board/contributors/dr-kate-baker
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