Chakrabarti, Sakti

864 Background: Definitive chemoradiotherapy (CRT) is the standard of care for localized or locally advanced ACSCC, while surgery is typically reserved for salvage therapy. Outcome of treatment with local excision alone is unknown and is currently not recommended by NCCN. We retrospectively analyzed outcome of the patients with small (T1 lesion) incidentally found ACSCC who were treated with local excision alone. Methods: On retrospective analysis, a cohort of 12 patients with pathologically confirmed stage I ACSCC treated at Mayo Clinic between 1994 and 2014 was identified who were managed with local excision alone. Baseline as well as followup data were obtained by electronic chart review. Results: Median age of the patients at diagnosis was 68 years (range: 36-81 years) and majority were females (76.9%). Median follow-up duration was 7.5 years. Of the 12 patients, 2 patients did not receive standard CRT due to co-morbid conditions and other 10 patients chose surveillance over CRT. There was only one patient with disease recurrence at 3 years which was salvaged by abdominoperineal resection (APR). This subject remains alive and disease free at the time of data collection (4 years out from APR). There were 4 deaths, all unrelated to ACSCC. Of 12 patients, 10 patients (83%) remained disease free at 5 years and beyond, 1 patient had recurrence and 1 patient was lost to follow up at 5 months from diagnosis. Conclusions: Local excision as a single modality of treatment may be safe and effective for highly selected small stage I ACSCC. Further clinical study is warranted to accurately define the patient population who can be treated with local excision alone, potentially sparing them long term toxicities.

Abstract Checkpoint inhibitors targeted at programmed cell death-1 receptor (PD-1) and its ligand (PD-L1) can result in significant benefit to a small proportion of patients with cancer, including those with tumors of the stomach and gastroesophageal junction. These drugs are now approved for several solid tumors, including the recent accelerated approval of pembrolizumab for gastroesophageal adenocarcinomas in the third-line setting and beyond based on the KEYNOTE-059 phase II trial. Data are lacking on the efficacy of chemotherapy after progression on PD-1 blockade in metastatic gastroesophageal adenocarcinoma. This report describes the exceptional response of two patients who received ramucirumab plus paclitaxel after progressive disease on pembrolizumab. This early clinical observation suggests that the sequence of administration of PD-1 blockade and chemotherapy may be important in this disease.