Join moderator Caroline DiCristo, PharmD, Associate Medical Director – Zanidatamab of Jazz Pharmaceuticals, alongside Dr. Noman Ashraf, MD, of Tampa General Hospital Cancer Institute for the final installment of the Advancing Care in GI and Biliary Tract Cancers podcast series. This episode focuses on gastroesophageal adenocarcinoma (GEA), exploring the disease state, patient management strategies, and the critical role of the multidisciplinary team (MDT) in delivering comprehensive, high-quality care.

Gastroesophageal adenocarcinoma represents a complex and evolving disease spectrum, encompassing malignancies of the esophagus, gastroesophageal junction, and stomach. With rising incidence rates, particularly in Western populations, clinicians are increasingly faced with challenges related to delayed diagnosis, heterogeneous disease biology, and the need for coordinated, team-based care.

Understanding GEA Disease Presentation and Risk Factors

The discussion begins with a foundational overview of GEA, including its epidemiology and key risk factors. While historically associated with smoking and alcohol use in squamous cell carcinoma, the rise in adenocarcinoma is closely linked to obesity, gastroesophageal reflux disease (GERD), and Barrett’s esophagus. Patients often present with non-specific or late-stage symptoms, such as dysphagia, weight loss, or anemia, contributing to delayed diagnosis and more advanced disease at presentation.

The Importance of Multidisciplinary Care

A central theme of the episode is the essential role of the multidisciplinary team in both diagnosis and treatment planning. From gastroenterologists performing endoscopic evaluation and biopsy, to pathologists guiding biomarker testing, and oncologists, surgeons, and radiation specialists determining treatment strategy, effective collaboration is critical. Additional support from dietitians, rehabilitation specialists, and speech therapists further underscores the complexity of managing GEA and optimizing patient outcomes.

Diagnostic Workup and Staging

The episode outlines the stepwise approach to confirming a diagnosis and staging disease, including endoscopy with biopsy, imaging with CT and PET scans, and endoscopic ultrasound (EUS) for local staging. Accurate staging is emphasized as the most important prognostic factor and a key determinant in guiding treatment decisions.

Biomarker-Driven Treatment in Advanced Disease

In the metastatic setting, treatment has become increasingly personalized, driven by biomarker testing. The discussion highlights the importance of assessing MSI status, HER2 expression, PD-L1 status, and Claudin 18.2 to inform therapy selection. Advances in immunotherapy and targeted treatments have significantly expanded options beyond traditional chemotherapy, allowing for more tailored and effective approaches based on individual tumor biology.

Emerging Therapies and Evolving Landscape

The episode also explores the rapidly evolving treatment landscape, including promising data from recent clinical trials evaluating HER2-targeted therapies such as zanidatamab. These emerging approaches may reshape standard of care and improve outcomes for patients.

Patient-Centered, Team-Based Decision Making

Through clinical insights and real-world perspectives, Dr. Ashraf emphasizes the importance of aligning treatment decisions with patient needs, preferences, and overall health status. Shared decision-making, supported by a coordinated care team, remains essential in navigating the complexities of GEA management.

Tune in for a comprehensive discussion on gastroesophageal adenocarcinoma and how multidisciplinary collaboration, biomarker-driven care, and emerging therapies are shaping the future of treatment in GI cancers.

Join moderator Caroline DiCristo, PharmD, Associate Medical Director – Zanidatamab of Jazz Pharmaceuticals, alongside Dr. Noman Ashraf of Tampa General Hospital Cancer Institute and Dr. Umair Majeed of Mayo Clinic in Jacksonville for the third installment of the Advancing Care in GI and Biliary Tract Cancers podcast series. This episode explores HER2-targeted agents in GI malignancies, with a focus on understanding their distinct mechanisms of action and how these differences influence treatment selection.

HER2 alterations are increasingly recognized across biliary tract, gastric, and colorectal cancers, with a growing number of targeted therapies available. As treatment options expand, understanding how each class of HER2-directed therapy works has become essential for optimizing patient outcomes and tailoring care based on both disease biology and individual patient factors.

Mechanisms of Action Across HER2-Targeted Therapies

The discussion highlights the key differences between major classes of HER2-targeted agents used in GI cancers:

• Monoclonal Antibodies: Agents such as trastuzumab and pertuzumab bind to HER2 receptors and inhibit downstream signaling pathways.
• Bispecific Antibodies: Novel therapies like zanidatamab target two distinct HER2 epitopes, enhancing receptor binding and immune-mediated activity.
• Antibody–Drug Conjugates (ADCs): These agents deliver cytotoxic payloads directly to HER2-expressing cells, combining targeted therapy with chemotherapy-like effects.
• Tyrosine Kinase Inhibitors (TKIs): Oral agents that block intracellular HER2 signaling and offer an alternative mechanism with distinct toxicity profiles.

Clinical Considerations in Therapy Selection

Dr. Ashraf and Dr. Majeed emphasize that selecting the appropriate HER2-directed therapy requires careful consideration of multiple factors, including prior treatment exposure, comorbidities, and patient preferences. Cardiac function, pulmonary health, and tolerance to prior chemotherapy all play a role in determining the most suitable option. Additionally, differences in side effect profiles across drug classes, such as cytopenias, diarrhea, and interstitial lung disease, must be carefully weighed.

Patient-Centered Decision Making

Through real-world case examples, the discussion underscores the importance of incorporating patient preferences into treatment planning. Whether prioritizing quality of life, minimizing specific toxicities, or avoiding chemotherapy-related side effects, shared decision-making remains central to optimizing outcomes in HER2-positive GI cancers.

Evolving Treatment Landscape

As more HER2-targeted therapies receive approvals and guideline recommendations, clinicians are faced with increasing complexity in sequencing and selecting treatments. While data on optimal sequencing strategies remain limited, ongoing research and insights from other tumor types may help inform future approaches.

Tune in for an in-depth discussion on HER2-targeted therapies in GI cancers and how a deeper understanding of mechanisms of action can guide more personalized, effective treatment strategies for patients.

Join moderator Caroline DiCristo, PharmD, Associate Medical Director – Zanidatamab of Jazz Pharmaceuticals, alongside Dr. Paresh Patel and Dr. Masoumeh Ghayouri for the second installment of the Advancing Care in GI and Biliary Tract Cancers podcast series. This episode focuses on HER2 testing in biliary tract cancers (BTC) and gastroesophageal adenocarcinoma (GEA), two GI malignancies where HER2 overexpression is increasingly recognized as an important biomarker for targeted therapy.

HER2 has long been a key therapeutic target in breast cancer, but research now shows that HER2 overexpression occurs in up to 30 percent of biliary tract cancers and approximately 20 percent of gastroesophageal adenocarcinomas. As targeted treatment options expand, identifying HER2 status has become a critical step in guiding treatment decisions for patients with advanced disease.

Testing Methods and Timing

The discussion explores current guideline recommendations for HER2 testing and the importance of evaluating HER2 status early in the disease course for patients with advanced or metastatic BTC and GEA. Experts review the primary diagnostic methods used to determine HER2 expression:

• Immunohistochemistry (IHC): A first-line test that evaluates HER2 protein overexpression in tumor cells. • Fluorescence In Situ Hybridization (FISH): Used to confirm HER2 gene amplification when IHC results are equivocal. • Next Generation Sequencing (NGS): A broader molecular profiling approach that can detect HER2 amplification along with additional actionable mutations.

Challenges in GI HER2 Testing

The episode also highlights several practical challenges associated with HER2 testing in GI malignancies. Tumor heterogeneity can lead to variation in HER2 expression between biopsy samples, making accurate tissue sampling and interpretation essential. Additionally, GI cancers follow distinct HER2 scoring guidelines compared with breast cancer, requiring specialized pathology expertise to ensure proper classification.

Multidisciplinary Collaboration

Dr. Patel and Dr. Ghayouri emphasize the importance of close collaboration between oncologists and pathologists when interpreting HER2 test results and determining appropriate treatment strategies. Communication between specialties, including tumor board discussions and repeat biopsies when necessary, helps ensure patients receive the most accurate diagnosis and access to targeted therapies when appropriate.

Tune in for a discussion on the growing role of HER2 testing in GI cancers and how precision diagnostics and multidisciplinary care are shaping the future of treatment for patients with biliary tract cancers and gastroesophageal adenocarcinoma.

Join moderator Caroline DiCristo, PharmD, Associate Medical Director – Zanidatamab of Jazz Pharmaceuticals and GI Oncologist Dr. Umair Majeed of Mayo Clinic in Jacksonville for the first installment of the Advancing Care in GI and Biliary Tract Cancers podcast series, focused on biliary tract cancers.

The first in the series, this episode provides a comprehensive overview of biliary tract cancers, including intrahepatic and extrahepatic cholangiocarcinoma and gallbladder cancer, highlighting their rarity, evolving epidemiology, and complex biology. Dr. Majeed reviews key risk factors such as chronic liver inflammation, primary sclerosing cholangitis, viral hepatitis, gallstones, and metabolic-associated liver disease, emphasizing the importance of early suspicion and multidisciplinary awareness.

Diagnosis & Staging Complexity: The discussion outlines the critical steps required to confirm diagnosis and stage disease accurately:

• Imaging Workup: The role of CT chest, MRI abdomen, and PET imaging in determining resectability and metastatic spread.

• Tissue Acquisition Challenges: Endoscopic approaches, biopsy considerations, and the importance of avoiding peritoneal violation in transplant-eligible hilar cholangiocarcinoma.

• Tumor Markers: Use of CA 19-9 for monitoring disease trends.

• Multidisciplinary Coordination: Collaboration among oncology, gastroenterology, surgery, radiology, pathology, and hepatology teams to optimize patient care.

First-Line Treatment & Molecular Testing:

Dr. Majeed discusses the current standard of care for metastatic disease, including chemoimmunotherapy based on the TOPAZ-1 and KEYNOTE-966 trials, and underscores the critical role of next-generation sequencing in identifying actionable mutations.

HER2 as an Emerging Target:

The episode also introduces HER2 as a clinically meaningful biomarker in biliary tract cancers, particularly in gallbladder and extrahepatic subtypes. Dr. Majeed reviews testing strategies, the importance of immunohistochemistry and confirmatory FISH testing, and emerging second-line HER2-directed therapies that may extend survival while offering chemotherapy-free intervals for appropriate patients.

Tune in for an in-depth discussion on the evolving diagnostic and therapeutic landscape of biliary tract cancers and the essential role of precision medicine and multidisciplinary collaboration in improving outcomes

Join Dr. Edgardo Santos and Dr. Luis Raez for a practical discussion on first-line decision-making in EGFR-mutated lung cancer and how early treatment choices shape survival, sequencing, and patient experience.

This episode explores why first-line therapy represents a critical window for long-term benefit, including the reality that many patients never reach later lines of treatment and the importance of early disease control. The speakers review guideline-supported first-line strategies, discuss how clinicians interpret survival and durability data, and examine the role of CNS disease as a key factor in treatment selection.

The conversation also addresses real-world implementation considerations, including adverse event management, administration and dosing factors, and how early patient education can improve treatment adherence and experience. Learn how interdisciplinary care teams provide proactive support to help optimize outcomes in the first months of therapy.

Tune in for key insights on optimizing first-line strategy and supporting patients from the start of therapy.

Join Dr. Paresh Patel and Dr. Masoumeh Ghayouri for a crucial conversation on the complexities of HER2 testing in Gastrointestinal (GI) cancers, including Gastroesophageal Adenocarcinoma (GEA) and Biliary Tract Cancer (BTC).

HER2 status is essential for accessing targeted treatments, but its interpretation in GI cancers is unique and challenging. This episode dives into:

• GI vs. Breast Guidelines: Understanding the critical differences in interpreting HER2 Immunohistochemistry (IHC) results, including scoring criteria, membrane staining requirements, and tissue sampling specifics (e.g., cohesive cell clusters in biopsies).
• Testing Rationale and Methods: Why first-line HER2 testing is now standard for BTC and GEA, and the advantages of using Next-Generation Sequencing (NGS) to assess multiple biomarkers simultaneously alongside IHC and ISH.
• The Power of Collaboration: The vital need for oncologists and pathologists to work closely together to ensure accurate tissue sampling, correct test interpretation, and ultimately, determine patient eligibility for life-prolonging HER2-targeted medications.

Gain insights into best practices that are necessary to overcome challenges like intratumoral heterogeneity and ensure high-quality biomarker testing for GI cancer patients.

Join Dr. Paresh Patel and Dr. Masoumeh Ghayouri for a crucial conversation on the complexities of HER2 testing in Gastrointestinal (GI) cancers, including Gastroesophageal Adenocarcinoma (GEA) and Biliary Tract Cancer (BTC).

HER2 status is essential for accessing targeted treatments, but its interpretation in GI cancers is unique and challenging. This episode dives into:

• GI vs. Breast Guidelines: Understanding the critical differences in interpreting HER2 Immunohistochemistry (IHC) results, including scoring criteria, membrane staining requirements, and tissue sampling specifics (e.g., cohesive cell clusters in biopsies).
• Testing Rationale and Methods: Why first-line HER2 testing is now standard for BTC and GEA, and the advantages of using Next-Generation Sequencing (NGS) to assess multiple biomarkers simultaneously alongside IHC and ISH.
• The Power of Collaboration: The vital need for oncologists and pathologists to work closely together to ensure accurate tissue sampling, correct test interpretation, and ultimately, determine patient eligibility for life-prolonging HER2-targeted medications.

Gain insights into best practices that are necessary to overcome challenges like intratumoral heterogeneity and ensure high-quality biomarker testing for GI cancer patients.

Join moderator Dr. Tiago Bianchi and an expert multidisciplinary panel, including Zilipah Cruz, MSN-RN, ONN-CG, Vanessa Sepulveda-Dominguez, RN, BSN, and Charlotte Martin, PharmD, for a deep dive into the essential non-clinical aspects of metastatic colorectal cancer (mCRC) care.

This episode explores the critical role of the entire oncology team in addressing the Social Determinants of Health (SDOH) and supporting patient survivorship.

Key Challenges & Team Coordination: The panel will discuss the reality of holistic patient support, drawing on survey findings:

• SDOH Screening Gaps: While 68% of clinicians report screening for SDOH, most are not using standardized tools, leading to inconsistent identification of patient needs.
• Support & Barriers: Despite 90% of teams reporting access to support resources (e.g., nurse navigation, pharmacy, social work), implementation varies. The top real-world barriers remain insurance, transportation, patient education, and cost.
• The Interdisciplinary Team: Hear how RNs, APPs, PharmDs, and Navigators coordinate care, from assessing SDOH to integrating screening into the EHR, to provide seamless support.

Unique Survivorship Concerns: The conversation addresses the unique survivorship challenges faced by younger mCRC patients, including:

• Managing fertility and sexual health concerns.
• Facilitating the return to work and maintaining career stability.
• The importance of clear patient education, communication, and managing treatment expectations to improve long-term quality of life.

Tune in for a vital discussion on how care teams move beyond clinical treatment to provide comprehensive, coordinated support for the whole mCRC patient.

The mCRC Journey: Treatment Sequencing and Real-World Decisions (Epi. 2)

Join medical oncologists Dr. Tiago Bianchi and Dr. Raji Shameem for Episode 2 of our "Voices in Colorectal Cancer" Series as they navigate the complex, guideline-based, and real-world treatment landscape for metastatic colorectal cancer (mCRC).

This episode delves into current practice, informed by key insights from a recent FLASCO survey:

• Molecular Profiling: The doctors confirm molecular profiling is widely adopted (86% of respondents test patients >90% of the time). However, they discuss persistent gaps related to insurance barriers and challenges with specimen quality.
• Sequencing Strategies: Explore the current NCCN mCRC treatment pathways and the variety in real-world sequencing decisions after initial chemotherapy. The discussion contrasts community versus academic approaches to later-line decision-making.
• New Horizons: Learn where biomarker-agnostic therapies fit into the mCRC journey and how novel treatments are integrated into existing protocols.
• Access & Trials: The doctors address common access issues, prior authorization, and payer challenges that complicate care. Finally, they discuss the critical—yet often delayed—process of clinical trial referral, highlighting timing and lack of awareness as the primary barriers.

Tune in to understand the complexities of mCRC management, from biomarker testing to strategic sequencing and overcoming systemic access hurdles.

In this first episode of the "Voices in Colorectal Cancer" Series, medical oncologists Dr. Tiago Bianchi and Dr. Raji Shameem confront the dramatic shift in colorectal cancer (CRC) presentation, drawing on urgent, real-world data from a recent FLASCO survey.

The Troubling Trend:

• Younger: 91% of clinicians report seeing more CRC cases in patients under age 50, mirroring incidence spikes in Florida and across the US.
• Later: More than half of all cases are presenting as late-stage at diagnosis—a major gap in current cancer care that severely impacts survival.
• Sicker: This late presentation means younger patients face more aggressive treatment and unique survivorship challenges, significantly affecting their quality of life, including financial and functional well-being.

Addressing the Gaps: The doctors discuss the primary barriers driving these trends: lack of primary care relationships, payer issues, and patient education deficits. They highlight the critical need for:

• Updated screening practices and increased awareness among primary care providers.
• Targeted education and primary care partnerships to improve timely diagnosis and prevention.

Tune in to understand why CRC is increasingly a disease of the young, the consequences of delayed diagnosis, and what the oncology community is doing to bridge the gaps in screening and prevention.