"Targeted" Chemotherapy for Esophageal Cancer

Due to its increasing incidence and low survival rate, esophageal cancer (EC) is now considered, even by non-medical professionals, as an extremely difficult cancer to beat akin to well-known terminal indications such as pancreatic and lung cancers. The average 5-year survival of EC is less than 18% and currently has the fastest rising rate of incidence of all cancers diagnosed in the United States (1). A number of cancer types have had double-digit improvements in survival statistics in the last 30 years; however, EC has not experienced a jump in the positive direction in regards to improved outcomes even as the number of therapeutic options has grown (2). Having analyzed patient management strategies of hundreds of EC patients, it is apparent that survival rates are unlikely to improve significantly until there is an availability of new FDA-approved anticancer and immunotherapy drugs. Currently, most EC patients are prescribed a combination of platinums, taxanes, anthracyclines, or pyrimidine analogs. Targeted therapies [anti-receptor tyrosine-protein kinase erbB-2 (HER2) and anti-epidermal growth factor receptor (EGFR)] are sometimes used in concert with chemoradiation. Immunotherapy clinical trials for EC are in their infancy, especially in the first-line setting. The standard of care for patients with stages II-III EC usually consists of chemotherapy, or chemoradiation either in the neoadjuvant or adjuvant setting of esophagectomy (removal of the esophagus via surgical intervention). As of now, no grouping of chemotherapeutic agents has been clearly demonstrated to be the most effective combination therapy in the EC patient population. Thus, on top of dealing with the adverse effects of an extensive surgery, patients are subjected to sporadically ineffective chemotherapy regimens. This expensive and rigorous perioperative therapy protocol typically yields a short survival benefit over surgery alone (3, 4). © 2017 Abdo, Agrawal and Mittal.