Michael Shusterman, MD
@mshusterman.bsky.social
GI Medical Oncologist @ NYU Perlmutter Cancer Center, Associate Fellowship Program Director @ NYU Grossman Long Island School of Medicine #meded
Difficult without data. We could not perform analysis due to limited recurrence & survival dataset quality. This will remain provider/institution specific. We dropped 5-FU bolus as an institution, mFOLFOX6 ➡️ mFOLFOX7.
November 29, 2024 at 10:33 PM
Difficult without data. We could not perform analysis due to limited recurrence & survival dataset quality. This will remain provider/institution specific. We dropped 5-FU bolus as an institution, mFOLFOX6 ➡️ mFOLFOX7.
8) TAS‐102 (trifluridine/tipiracil) plus bevacizumab every other week may be more tolerable and induce lower neutropenia rates.
pmc.ncbi.nlm.nih.gov/articles/PMC...
ascopubs.org/doi/10.1200/...
pmc.ncbi.nlm.nih.gov/articles/PMC...
ascopubs.org/doi/10.1200/...
ASCO Publications
ascopubs.org
November 25, 2024 at 2:51 AM
8) TAS‐102 (trifluridine/tipiracil) plus bevacizumab every other week may be more tolerable and induce lower neutropenia rates.
pmc.ncbi.nlm.nih.gov/articles/PMC...
ascopubs.org/doi/10.1200/...
pmc.ncbi.nlm.nih.gov/articles/PMC...
ascopubs.org/doi/10.1200/...
7) Capecitabine can likely be given in the metastatic setting at a fixed dose and 7 days on and 7 days off for many patients. Retrospectively studied in colon cancer (www.clinical-colorectal-cancer.com/article/S153.... Prospective data in breast cancer (ascopubs.org/doi/10.1200/...).
Safety and Efficacy of 7 Days on/7 Days off Versus 14 Days on/7 Days off Schedules of Capecitabine in Patients with Metastatic Colorectal Cancer: A Retrospective Review
Micro-AbstractIn an attempt to improve the tolerability of capecitabine in patients
with metastatic colorectal cancer (mCRC), an every other week treatment schedule (7/7)
is often administered. In thi...
www.clinical-colorectal-cancer.com
November 25, 2024 at 2:48 AM
7) Capecitabine can likely be given in the metastatic setting at a fixed dose and 7 days on and 7 days off for many patients. Retrospectively studied in colon cancer (www.clinical-colorectal-cancer.com/article/S153.... Prospective data in breast cancer (ascopubs.org/doi/10.1200/...).
6) FOLFIRINOX (modified) doses in pancreatic cancer are almost certainly too high for most patients. Lower doses of NALIRIFOX produced identical outcomes. Oxaliplatin 65 and Irinotecan 125-135 is likely more tolerable and equally effective.
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma (NAPOLI 3): a randomised, open-label, phase 3 trial
Our findings support use of the NALIRIFOX regimen as a possible reference regimen
for first-line treatment of mPDAC.
www.thelancet.com
November 25, 2024 at 2:39 AM
6) FOLFIRINOX (modified) doses in pancreatic cancer are almost certainly too high for most patients. Lower doses of NALIRIFOX produced identical outcomes. Oxaliplatin 65 and Irinotecan 125-135 is likely more tolerable and equally effective.
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
5) Dose escalation of Regorafenib 80-120-160 is a boards question now as a standard of care. Do not start at 160 mg dosing. Per ReDOS trial.
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
Regorafenib dose-optimisation in patients with refractory metastatic colorectal cancer (ReDOS): a randomised, multicentre, open-label, phase 2 study
The dose-escalation dosing strategy represents an alternative approach for optimising
regorafenib dosing with comparable activity and lower incidence of adverse events
and could be implemented in clin...
www.thelancet.com
November 25, 2024 at 2:37 AM
5) Dose escalation of Regorafenib 80-120-160 is a boards question now as a standard of care. Do not start at 160 mg dosing. Per ReDOS trial.
www.thelancet.com/journals/lan...
www.thelancet.com/journals/lan...
4) Gemcitabine Cisplatin every other week is more tolerable and has likely similar efficacy to Day 1, 8.
doi.org/10.1002/ijc....
doi.org/10.1002/ijc....
Biweekly cisplatin and gemcitabine in patients with advanced biliary tract cancer
What's new? Patients diagnosed with biliary tract cancer frequently present with advanced or metastatic disease, for which standard treatment entails an eight-week-long course of weekly administratio....
doi.org
November 25, 2024 at 2:32 AM
4) Gemcitabine Cisplatin every other week is more tolerable and has likely similar efficacy to Day 1, 8.
doi.org/10.1002/ijc....
doi.org/10.1002/ijc....
3) In older adults vulnerable adults, every other week Gemcitabine Nab-Paclitaxel should likely be a standard of care based on GIANT trial (ECOG-ACRIN EA2186).
ascopubs.org/doi/10.1200/...
ascopubs.org/doi/10.1200/...
A randomized phase II study of gemcitabine and nab-paclitaxel compared with 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with treatment-naïve metastatic pancreatic cancer (GI...
4003Background: Evidence-based data is lacking to guide the care of vulnerable older adults with
newly diagnosed metastatic pancreatic ductal adenocarcinoma (mPDAC) resulting in extrapolation
of the t...
ascopubs.org
November 25, 2024 at 2:30 AM
3) In older adults vulnerable adults, every other week Gemcitabine Nab-Paclitaxel should likely be a standard of care based on GIANT trial (ECOG-ACRIN EA2186).
ascopubs.org/doi/10.1200/...
ascopubs.org/doi/10.1200/...
2) Gemcitabine Nab-Paclitaxel every other week more tolerable and efficacy similar vs three weeks on.
“A modified regimen of biweekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis”
doi.org/10.1177/1758...
“A modified regimen of biweekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis”
doi.org/10.1177/1758...
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doi.org
November 25, 2024 at 2:29 AM
2) Gemcitabine Nab-Paclitaxel every other week more tolerable and efficacy similar vs three weeks on.
“A modified regimen of biweekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis”
doi.org/10.1177/1758...
“A modified regimen of biweekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis”
doi.org/10.1177/1758...
1) Avoid bolus 5-FU in metastatic regimens.
“Omission of 5-Fluorouracil Bolus From Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study”
doi.org/10.6004/jncc...
“Omission of 5-Fluorouracil Bolus From Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study”
doi.org/10.6004/jncc...
Omission of 5-Fluorouracil Bolus From Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study
Background: 5-Fluorouracil (5-FU) is a major component of gastrointestinal cancer treatments. In multidrug regimens such as FOLFOX, FOLFIRI, and FOLFIRINOX, 5-FU is commonly administered as a bolus fo...
doi.org
November 25, 2024 at 2:25 AM
1) Avoid bolus 5-FU in metastatic regimens.
“Omission of 5-Fluorouracil Bolus From Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study”
doi.org/10.6004/jncc...
“Omission of 5-Fluorouracil Bolus From Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study”
doi.org/10.6004/jncc...
Great to hear. We’d like to run a survey nationally of practice habits for bolus use. Wondering how best to reach most community oncologists?
November 24, 2024 at 1:42 PM
Great to hear. We’d like to run a survey nationally of practice habits for bolus use. Wondering how best to reach most community oncologists?
Interested what the practice among most oncologists is with bolus 5-FU in metastatic setting? How can we raise awareness to remove it from regimens? @oncbrothers.bsky.social @oncothor.bsky.social
November 23, 2024 at 8:13 PM
Interested what the practice among most oncologists is with bolus 5-FU in metastatic setting? How can we raise awareness to remove it from regimens? @oncbrothers.bsky.social @oncothor.bsky.social
We obtain MMR and HER2 IHC on all gastro-esophageal, biliary tract, small bowel, and colorectal adenocarcinoma biopsies as a reflex IHC pathway we developed with GI pathology.
November 23, 2024 at 8:11 PM
We obtain MMR and HER2 IHC on all gastro-esophageal, biliary tract, small bowel, and colorectal adenocarcinoma biopsies as a reflex IHC pathway we developed with GI pathology.
