Advances in the pharmacotherapeutic management of esophageal squamous cell carcinoma

ABSTRACT

Introduction

Esophageal squamous cancer remains an important cause of mortality worldwide with two new immunotherapy drugs recently approved for metastatic disease.

Areas covered

The authors review the epidemiology and genomics of esophageal squamous cell carcinoma. They also examine prior trials involving targeted agents under investigation as well immunotherapies that have been approved and novel combinations.

Expert opinion

Great advances have been made in characterizing the molecular changes in esophageal carcinoma. However, relatively few drugs have shown benefit in this disease. Targeted therapies have not shown to improve survival although many of these trials did not explore potential biomarkers. Pembrolizumab and nivolumab are now approved for esophageal squamous carcinoma but much more data are needed to understand how these agents may be used in non-metastatic settings. Novel treatments are still required as overall prognosis remains poor.

KEYWORDS:

• Cancer
• esophageal squamous cell carcinoma
• immunotherapy
• targeted therapy

Article highlights

• Esophageal squamous cell carcinoma remains an important cause of morbidity and is the sixth leading cause of cancer death worldwide

• Molecular studies have shown that esophageal squamous cell carcinoma is a distinct disease from esophageal adenocarcinoma and should be considered a separate entity

• Despite better understanding of genomic changes, no targeted therapies have been shown to improve survival, necessitating a better understanding of how molecular pathways interact

• Standard of care for localized disease has remained essentially the same with combination chemoradiation and surgery

• Immunotherapy represents a major advance in advanced esophageal squamous carcinoma

• Ongoing trials are working to answer how immunotherapy may be incorporated for treatment of localized disease

Despite progress in immunotherapy, overall survival remains poor and much more research is needed to elucidate better treatment options.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded