First immunotherapy has been approved for esophageal cancer treatment. Esophageal cancer is a common malignant tumor. The International Center for Cancer Research of the World Health Organization points out that esophageal cancer has now become the 6th highest incidence cancer in the world. China is also one of the regions with the highest incidence of esophageal cancer in the world. Some are squamous cell carcinoma.
The main treatments for esophageal cancer include surgery, radiotherapy, and chemotherapy. Squamous cell carcinoma is moderately sensitive to chemotherapy. Traditional chemotherapeutic drugs and radiation therapy have a high status in the treatment of esophageal squamous cell carcinoma. However, the prognosis of patients with advanced esophageal cancer after first-line chemotherapy is poor, and treatment options are limited. Taxane and irinotecan have been used after first-line treatment, but no overall survival benefit was seen in the Phase 3 study of chemotherapy.
In recent years, there have been many new attempts in the treatment of esophageal squamous cell carcinoma-molecular targeted drugs and immunotherapy, and great progress has been made.
Recently Merck announced:
The U.S. Food and Drug Administration (FDA) has approved PD-1 tumor immunotherapy Keytruda (creta, common name: pembrolizumab, pabolizumab) as a single drug therapy for PD-L1 (combined positive score [CPS] ≥ 10) and treatment of patients with recurrent locally advanced or metastatic esophageal squamous cell carcinoma (ESCC) who have progressed after one or more systemic therapies.”
The first immunotherapy for esophageal cancer
The approval is based on the results of a test code-named KEYNOTE-181 (NCT02564263).
KEYNOTE-181 is a multicenter, randomized, open-label, active controlled trial. 628 patients with recurrent locally advanced or metastatic esophageal cancer were included. These advanced patients progressed before and after first-line systemic treatment.
Patients were randomly assigned to receive palmumab 200 mg once every three weeks, or the following chemotherapy intravenous regimen: paclitaxel, docetaxel per, or irinotecan.
The results showed that compared with the chemotherapy group, patients with tumors with PD-L1 CPS ≥ 10 showed improvement in OS in patients who were randomly treated with Keytruda. The overall response rate of pembrolizumab is also higher than chemotherapy. These data suggest that pembrolizumab should be considered a new standard of care in patients with PD-L1 CPS of 10 or higher in second-line treatment.
Possible side effects: Pneumonia, colitis, hepatitis, endocrine disease, nephritis and renal dysfunction, severe skin reactions, solid organ transplant rejection and complications of allogeneic hematopoietic stem cell transplantation (HSCT). Depending on the severity of the adverse reaction, pembrolizumab should be discontinued or discontinued, and corticosteroid therapy should be given when appropriate.
Other treatment options for esophageal cancer
Chemotherapy in esophageal cancer
For the treatment of esophageal cancer, chemotherapy can be used at different times.
Adjuvant chemotherapy: chemotherapy after surgery. The goal is to kill any cancer cells that may be left during the procedure, because they are too small to be seen with the naked eye, so they cannot be removed surgically. It is also possible for cancer cells to escape from major tumors and take root in other parts of the body.
Neoadjuvant chemotherapy: For certain cancers, chemotherapy (usually combined with radiation therapy) is given before surgery to try to shrink the tumor and make the surgery easier to clear.
Chemotherapy for advanced cancer: For esophageal cancers that have spread to other organs, such as the liver, chemotherapy can also be used to help shrink tumors and relieve symptoms. Although it is unlikely to cure cancer, it can often help people live longer.
Common drugs used in esophageal cancer treatment
- Carboplatin and paclitaxel (can be used in combination with radiotherapy)
- Cisplatin and 5-fluorouracil (5-FU) (usually combined with radiation therapy)
- ECF: epirubicin, cisplatin, and 5-FU (especially tumors at the junction of the gastroesophagus)
- DCF: docetaxel, cisplatin, and 5-FU
- Cisplatin and capecitabine
- oxaliplatin and 5-FU or capecitabine
- Irinotecan
Targeted therapy in esophageal cancer
Ramucirumab (Cyramza)
Rumizumab is a humanized monoclonal antibody that specifically blocks vascular endothelial growth factor receptor 2 (VEGFR2) and downstream angiogenesis-related pathways. The currently approved indication is monotherapy or in combination with paclitaxel for advanced gastric cancer / gastroesophageal junction adenocarcinoma that progresses during or after chemotherapy with or without fluorouracil or platinum. In addition, it has been approved for the treatment of non-small cell lung cancer and metastatic colorectal cancer.
Trastuzumab (Trastuzumab, Herceptin)
Trastuzumab, a monoclonal antibody against Her2, prevents human epidermal growth factor from attaching to Her2 by attaching itself to Her2, thereby blocking the growth of cancer cells. Herceptin can also stimulate the body’s own Immune cells to destroy cancer cells.
Esophageal squamous cell carcinoma, as a very unique organ in our upper digestive tract tumors, directly affects eating. In addition, squamous cell carcinoma is more invasive and is prone to risk of obstruction, leakage and bleeding. Therefore, in the whole treatment process of squamous cell carcinoma, although we will use some traditional drug treatment methods and take into account some new attempts, we must implement the concept of full-course management throughout the treatment process. With the advancement of medicine, there will be more technologies to fight against esophageal cancer, such as proton radiotherapy, cellular immunotherapy, etc. Everyone must be confident.
