Basis for molecular diagnostics and immunotherapy for esophageal cancer

ABSTRACT

Introduction: Esophageal cancer (EC) is an extremely aggressive neoplasm, diagnosed in about 17,000 Americans every year with a mortality rate of more than 80% within five years and a median overall survival of just 13 months. For decades, the go-to regimen for esophageal cancer patients has been the use of taxane and platinum-based chemotherapy regimens, which has yielded the field’s most dire survival statistics.

Areas covered: Combination immunotherapy and a more robust molecular diagnostic platform for esophageal tumors could improve patient management strategies and potentially extend lives beyond the current survival figures. Analyzing a panel of biomarkers including those affiliated with taxane and platinum resistance (ERCC1 and TUBB3) as well as immunotherapy effectiveness (PD-L1) would provide oncologists more information on how to optimize first-line therapy for EC.

Expert commentary: Of the 12 FDA-approved therapies in EC, zero target the genome. A majority of the approved drugs either target or are effected by proteomic expression. Therefore, a broader understanding of diagnostic biomarkers could give more clarity and direction in treating esophageal cancer in concert with a greater use of immunotherapy.

KEYWORDS:

• Esophageal cancer
• precision medicine
• molecular oncology
• targeted therapy
• PD-L1 inhibitors
• CTLA-4 inhibitors
• combination immunotherapy
• proteomics
• targeted chemotherapy
• esophageal adenocarcinoma

Declaration of interest

K Agrawal has received research grants R01 HL112597, R01 HL116042, and R01 HL120659 to Dr. D.K. Agrawal from the National Heart, Lung and Blood Institute, National Institutes of Health, USA. 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.

Additional information

Funding

This work was supported by research grants R01 HL112597, R01 HL116042, and R01 HL120659 to Dr. D.K. Agrawal from the National Heart, Lung and Blood Institute, National Institutes of Health, USA. The content of this review article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.