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Michael Shusterman: GI Oncology standard regimen doses remain too high for many real world patients

Michael Shusterman/X

Dec 2, 2024, 09:57

Michael Shusterman: GI Oncology standard regimen doses remain too high for many real world patients

Michael Shusterman, Medical oncologist and Clinical Assistant Professor of Medicine in the Permutter Cancer Center at NYU Langone Hospital, posted on X:

“GI Oncology standard regimen doses remain too high for many real world patients. Retrospective and prospective trials demonstrating benefit of reduced doses or dose escalation are accumulating.

Avoid bolus 5-FU in metastatic regimens. “Omission of 5-Fluorouracil Bolus From Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study”

Gem Nab-Paclitaxel every other week tolerable and efficacy similar vs 3 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”

In older adults vulnerable adults by geriatric assessment, every other week Gemcitabine Nab-Paclitaxel should be a standard of care based on GIANT trial (ECOG-ACRIN EA2186).

Gemcitabine Cisplatin every other week is more tolerable and has likely similar efficacy to Day 1, 8.

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.

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.

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.

Prospective data in breast cancer.

TAS‐102 (trifluridine/tipiracil) plus bevacizumab every other week may be more tolerable and induce lower neutropenia rates.

If you know of other examples or practice patterns, please share!”