Advances in therapeutic options for esophageal and esophagogastric junctional adenocarcinoma

ABSTRACT

Introduction: The shifting location of esophageal cancers from proximal to distal and gastric cancers from distal to proximal has resulted in a marked increase in the incidence of esophageal adenocarcinoma (EAC) which also involves tumors localized at esophagogastric junction (EGJ). The trend of increased incidence of EAC has paralleled the upward trend in rates of obesity, gastroesophageal reflux disease (GERD), and the Barrett’s esophagus (BE). Despite the numerous identified targets, the survival rates of EACs has not changed much. Understanding the molecular biology in depth will help to achieve new and more effective therapeutic options and also may help to identify premalignant lesions before conversion to cancer.

Areas covered: In this review, we aimed to describe the advances in the therapeutic options for potentially resectable and unresectable EAC. A literature research was performed using PubMed, American Society of Clinical Oncology, European Society for Medical Oncology, and ClinicalTrials.gov websites.

Expert opinion: Adequate resection with adjunctive therapies is the backbone component of resectable EAC. Palliative chemotherapy with best supportive care remains as the standard of care for advanced stage disease. Understanding the molecular biology of EAC and its precursor BE will help to convert phenotypic treatment to the more promising genotypic treatment.

KEYWORDS:

• Esophageal adenocarcinoma
• esophagogastric junction cancer
• potentially resectable
• unresectable
• therapeutic option
• Barrett’s esophagus

Article highlights

• The incidence of EAC is promptly increasing parallel to the increasing incidence of obesity, GERD, and BE.

• Preventing EAC arising from BE by targeting stem cells could be a strategy to consider.

• For resectable EAC, ~15% increase in OS rates is possible with adjunctive therapies. Pre-operative chemoradiation, peri-operative chemotherapy and pre-operative chemotherapy are the options of adjunctive therapies.

• Pre-operative treatment is more tolerable and completion rate is considerably higher than post-operative treatment.

• Unresectable EAC is most often an incurable situation. Palliative chemotherapy with best supportive care is the standard of care.

• TCGA reported molecular characterization of esophageal carcinoma. With the molecular characterization, personalized treatment could replace the standard treatment in the coming decades.

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.

Additional information

Funding

This paper was not funded