Strategies to improve outcomes in esophageal adenocarcinoma

Abstract

Esophageal adenocarcinoma is one of the fastest rising cancers in Western society. Incidence has increased by 600% within the last 30 years. Rates of diagnosis and death run parallel due to the poor prognosis and a lack of effective treatments. Potentially curative treatments are followed by high rates of disease recurrence. For the majority of patients, who present with advanced disease, we have no effective treatment. We discuss the key areas of progress in this demanding field and offer our views on the direction of future research and treatment.

Keywords::

• Barrett’s esophagus
• esophageal adenocarcinoma
• esophageal cancer
• esophageal cancer diagnosis
• esophageal cancer prevention
• esophageal cancer treatment
• gastro esophageal reflux disease

Financial & competing interests disclosure

A Cowie is funded by a grant from the Royal College of Surgeons of England; F Noble is funded by a grant from Cancer Research UK; T Underwood is funded by a grant from the Medical Research Council. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The incidence of esophageal adenocarcinoma is rising worldwide but most rapidly in the west.

• Trials assessing screening, surveillance and chemoprevention near their conclusion.

• New endoscopic therapies seem promising, but lack long-term efficacy, cost-effectiveness and comparison with established treatment modalities.

• Neoadjuvant therapy is now established in treating patients with locoregional esophageal cancer, but as yet the optimum treatment algorithm is undefined.

• There are no clinically useful predictors of response to neoadjuvant therapy.

• Morbidity and mortality continue to fall, following surgery with continued innovation in the perioperative treatment pathway.

• The International Cancer Genome Consortium and similar consortia are defining the genetic landscape of esophageal adenocarcinoma providing the potential to develop personalized medicine as well as novel therapies.

Notes