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A. Craig Lockhart, MD
ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified) )| Communities: Colon and Rectal Cancer , Stomach Cancer , Pancreatic Cancer , Esophagus Cancer | Answers: 8 |
| Member Since: Jul. 2012 |
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Professional Statement
Dr. Lockhart is an Associate Professor of Medicine in the Section of Medical Oncology and the Director of the Developmental Therapeutics Program for the Siteman Cancer Center. He joined the faculty of Washington University School of Medicine in 2008. His clinical interests are in the areas of new oncology drug development and cancers of the gastrointestinal (GI) tract. As the Director of the Developmental Therapeutics program for the Siteman Cancer Center, his aim is to assist in the development of novel anticancer therapies by conducting Phase I clinical trials. Also he has an interest in incorporating genomics into these studies to eventually personalize cancer treatment. Being a member of the GI oncology clinical team, he has a particular interest in cancers of the upper GI tract. In this regard, he helps to design and conduct clinical trials for patients with esophageal, gastroesophageal junction and gastric cancers.
Professional Info
Credential: MD
Primary specialty: Oncology - Hematology/Oncology
Medical school: University of Texas, Southwestern Medical School
Residency: Washington University School of Medicine
Fellowship: Duke University Medical Center
Areas of expertise: Gastroentestional cancer (anus, bile duct, colon, esophagus, gallbladder, pancreas, rectum, small intestine)
Research interests: Phase 1 clinical trials
Hospital affiliation: Siteman Cancer Center, Barnes-Jewish Hospital
Practice address:
4921 Parkview Ave.
St. Louis, MO
63110
Practice phone number: 314-747-7222
ACraigLockhartMD Activities
Phase 1 trials are generally the first time that a new drug or a new drug combination is being tested in patients. Therefore our typical goals are to: 1) establish the correct dose or doses of the medication(s), usually referred to as the maximum tolerated dose (MTD); 2) to document the toxicities associated with the regimen under study; 3) to evaluate how the drug or drugs behave in the body, that being how quickly the drugs get to their highest concentration in the blood (and or urne) and long how it takes for the drug to be cleared out of the body. This is referred to as pharmacokinetics (PK); and 4) to see if there are any signs that the drug or drug combination works in particular tumors.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
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9 months ago
Is chemoradiation therapy common for esophageal cancer? Does it work better than chemotherapy alone?
Combining chemotherapy and radiation therapy in esophageal cancer is a very common therapeutic approach. We use this bi-modality approach when we are trying to shrink a tumor to facilitate surgery (neoadjuvant or preoperative therapy) and we also use this approach in some patients who cannot have surgery as this treatment strategy can cure some patients even without surgery. On some occasions we use chemotherapy and radiation together when patients have cancer that has spread beyond the esophagus as this combination increases the tumor shrinkage rate which can be helpful in certain clinical settings. Chemotherapy can sensitize the tumor cells so radiation is more effective, so this combined modality approach is generally more successful than either radiation or chemotherapy alone.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
There is not one standard regimen. I would recommend HER-2 testing first before a decision is made. In HER-2 negative patients, combination regimens of epirubicin, oxaliplatin & capecitabine (EOX); docetaxel, cisplatin & 5-FU (DCF) or cisplatin plus 5-FU or capecitabine are all reasonable regimens supported by Phase III clinical trial data. Other options including 5-FU, leucovorin & oxaliplatin (FOLFOX or XELOX if capecitabine is used) are also reasonable. If HER-2 positive, all of the above can be considered and combiined with trastuzumab, with the exception of the epirubicin.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
1
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9 months ago
Neoadjuvant therapy is recommended for patients with "locally advanced" cancers that have not metastasized beyond regional lymph nodes. I generally use this approach in patients whose tumors are T3 or larger (T2 if the histology is poorly differentiated) or any patient whose tumor has spread to the local lymph nodes. Some oncologists believe that surgery is only needed in patients with adenocarcinomas of the esophagus and that patients with squamous cell histology can be successfully treated with chemotherapy and radiation therapy alone, where surgery is used in the salvage setting. That approach is not universally accepted.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
1
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9 months ago
In general CT scans are used to follow the response to chemotherapy as CT scans give excellent anatomical detail so that precise tumor measurements to measure response to treatment are possible. In some patients where discrete lesions are difficult to visualize, PET scans can be helpful.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
The HER-2 receptor is a key member of the EGFR family of tyrosine kinase receptors. Signaling through this pathway is associated with tumor development, progression and metastasis in many cancers including tumors of the esophagus. Some studies indicate that the presence of the HER-2 receptor on esophageal tumors is associated with a more aggressive tumor type. However, the overexpression of this protein allows us to pursue therapy with drugs that are specifically targeted to that receptor. At this point the only drug approved for this indication is trastuzumab which is most often administered along with chemotherapy. The best survival outcomes in Phase 3 studies in patients with these tumors have been seen when trastuzumab was given (along with chemotherapy) to patients whose tumors express HER-2.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
VEGF is frequently expressed in esophagogastric cancers, and its expression appears to increase with increasing tumor stage. Additionally, high VEGF expression is a negative prognostic factor for survival in patients with these cancers. In animal xenograft studies, targeting VEGF was a successful approach prompting the clinical evauation of VEGF targeted therapies. So far however, the results from clinical trials using bevacizumab, sunitinib and sorafenib have been disappointing, but the rationale to further investigate this therapeutic pathway remains compelling. Some studies targeting VEGF for these cancers are ongoing, but no drugs specifically targeting VEGF are approved for use.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
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9 months ago
Evaluations of targeted therapies in esophageal cancers has met with mixed degrees of success. The ToGA study demonstrated the utility of adding trastuzumab to a chemotherapy regimen in patients whose tumors express HER-2. So far however, studies evaluating antiangiogenic drugs and epidermal growth factor receptor (EGFR) targeted drugs have been disappointing, so these agents are not approved for use in this cancer. Recent Phase 2 studies looking at some multikinase inhibitors and MET inhibitors look promising so we are in the process of evaluating these drugs further.
New answer by ACraigLockhartMD (Physician - Oncology - Hematology/Oncology (Verified))
1
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9 months ago
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