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Oncology Hematology summary Pulmonary embolism and lle dvt provoked by cancer arteries Eliquis 11/24-present Iron deficiency anemia due to bleeding. Ferrotom 11 Esophageal adenocarcinoma HER2 3+ MSS presentation with dysphagia. EEGD 9/27/24 fungating mass at GEJ, biopsy invasive adenocarcinoma, HER@ 3= and MSS. CT CAP 10/8/24 distal esophageal mass and peri-esophageal lymph node enlargement x 2 PET 10/20/24 GEJ with ,astatic regional LN, left supra clav is intermediate stage cT3ND2M0 Carboplatin and paclitaxel weekly concurrent with RT with neoadjuvant intent 10/30/24 with chemo 11/12/24 - 12/10/24 (scheduling). PET 1/14/25 very good partial response. Ivor-Lewis esophagectomy and partial gastrectomy 3/6/25 Dr. Adams path 5cm moderately differentiated adenocarcinoma, focally invading muscular propria 2/26 LN involved ypT2N1. Nivolumab with adjuvant intent4/16/25 -present. CT CAP 4/16/35 c/f enlarging retroperitoneal LN Chris Mcpeek is a 55 yr y.o male being evaluated today management of esophageal cancer he has been feeling received first dose of adjuvant nivolumab Results Today I views the radiographic images Pet dated 5/4/25 My interpretation multifocal Rp hypermetabolic LAD c/f malignancy, linear posterior RUL pleural uptake. IMPRESSION- Chris Mcpeek is a 55 y.o male with esophageal cancer s/p neoadjuvant chemo RT followed by esophagectomy with residual disease. Same dat he started adjutant nivolumab he was found to have concerning lymph node proregression confirmed by PET I advised it is possible this is reactive surgery however i am highly conversed this represent disease progression. We will obtain Tempus NGS/PD-L1 information and likely plan toward FOLFOX iratumumab and likely pembrolizumab if Pd-L1 > 1% We will also screen for trial enrollment. I suggested holding nivolumab. But he requested receiving tomorrow.

Patient Overview: Chris Mcpeek is a 55-year-old male undergoing evaluation for esophageal cancer management. He has received his first dose of adjuvant nivolumab and has a history of multiple treatments, including neoadjuvant chemotherapy and radiation therapy followed by esophagectomy.

Current Condition: Recent imaging, including a PET scan, indicates multifocal retroperitoneal hypermetabolic lymphadenopathy suggestive of malignancy. There are also signs of linear uptake in the right upper lobe pleura, raising concerns about possible disease progression.

Next Steps: Further testing will include Tempus NGS and PD-L1 assessment to guide treatment decisions. A plan may involve FOLFOX and potentially pembrolizumab if PD-L1 levels are favorable. The recommendation is to hold off on nivolumab treatment for now, although the patient expressed a desire to continue receiving it.

Patient Overview: Chris Mcpeek is a 55-year-old male undergoing evaluation for esophageal cancer management. He has received his first dose of adjuvant nivolumab and has a history of multiple treatments, including neoadjuvant chemotherapy and radiation therapy followed by esophagectomy.

Current Condition: Recent imaging, including a PET scan, indicates multifocal retroperitoneal hypermetabolic lymphadenopathy suggestive of malignancy. There are also signs of linear uptake in the right upper lobe pleura, raising concerns about possible disease progression.

Next Steps: Further testing will include Tempus NGS and PD-L1 assessment to guide treatment decisions. A plan may involve FOLFOX and potentially pembrolizumab if PD-L1 levels are favorable. The recommendation is to hold off on nivolumab treatment for now, although the patient expressed a desire to continue receiving it.

Patient Overview: Chris Mcpeek is a 55-year-old man being assessed for treatment of esophageal cancer. He has started his first dose of nivolumab and has a background of various treatments, including chemotherapy, radiation, and surgery to remove part of his esophagus.

Current Condition: Recent scans, like a PET scan, show multiple swollen lymph nodes that may indicate cancer. There are also unusual signs in the lung area that could mean the cancer is getting worse.

Next Steps: Additional tests, including genetic testing (Tempus NGS) and a PD-L1 test, will help decide on further treatment. There is a possibility of using FOLFOX and pembrolizumab if the PD-L1 results are good. For now, it is advised to pause nivolumab treatment, although the patient wishes to continue it.

Chart Summary