New drugs for the treatment of esophageal cancer

Treatment of esophageal cancer
Over 80% of patients with esophageal cancer are diagnosed in advanced stages of the disease, so we know they will have a very low survival (less than 10% at 5 years).

Existing therapeutic tools for the treatment of esophageal cancer are:

Surgery

Is the standard treatment in stage I to III (although we have already seen the prognosis at 5 years). Esophagectomy (removal of the esophagus) is a very aggressive surgery with high risk of postoperative complications and mortality rate of 5% (20 years ago was around 20%) due to better patient selection, improvements in surgical techniques and perioperative care. This technique should be added resection of locoregional lymph nodes (cervical, mediastinal, and celiac).

Preoperative chemotherapy

This mode (especially with cisplatin-based regimens and 5-fluorouracil) has moderate activity in advanced stages. The goal is to treat micrometastases present at diagnosis and reduce the size of the primary for better local control of esophageal cancer. Several studies have shown that, indeed, get better control of the disease (it seems that in adenocarcinomas responsive), but this does not translate into improved survival after surgery.

Chemotherapy and preoperative radiotherapy

The radiation therapy (RT) as the sole treatment of esophageal cancer is defined as palliative therapy to improve pain or difficulty swallowing (odynophagia and dysphagia). No benefit compared to surgery alone, but in combination with certain radiosensitizing drugs (which increase the biological potency of the RT in equal doses) expand local control of the cancer, while systemic disease (lesions are treated distance). Studies have shown that better control of the disease has an impact on the survival of patients with esophageal cancer and a reduction in mortality of up to 13% at 2 years. This benefit is seen in both adenocarcinomas and squamous.

Chemotherapy + Radiotherapy (RQT) radical

Following a study comparing RT alone versus RQT, which showed that the group of patients who had received RQT had greater survival and that survival was similar to other studies in patients undergoing surgery, the need arose (or not ) surgery in these patients receiving combination therapy. Several studies show that control of the disease is higher if treating RQT with surgery is completed, but survival is the same. In addition there is an increase in mortality from surgery. The question arises in the subgroup of patients with prior RQT where the disease is not controlled and observed that benefit from subsequent surgery.

The conclusion we can draw is that the option of RQT and subsequent surgery should be offered to patients with locally advanced esophageal cancer (T3-4N0-1M0) having resectability criteria. Conversely, if patients are not physically (by age, associated diseases, etc.) RQT radical option is the most appropriate, as well as criteria in those with unresectable (T4).

Treatment of esophageal cancer in advanced stages

In these cases, chemotherapy (cisplatin and 5-fluorouracil) is of choice, with a response rate that does not go beyond 35% (57% with new drugs such as taxanes or irinotecan) and survival is less than 10 months. Symptom control (dysphagia) is achieved in 90% of cases.

Supportive care

The purpose of this treatment on the carrier is allowed esophageal cancer food intake and improve symptoms. We radiotherapy and laser resection of the tumor (in certain locations, sizes and shapes). Another option is endoscopic prosthesis placement to allow the passage of food, or in patients with tracheoesophageal fistula to ensure the integrity of the gut and respiratory respectively.

New drugs for the treatment of esophageal cancer

We observed an overexpression of EGFR (Epidermal Grow Factor Receptor) by up to 70%. Is a membrane receptor of tumor cells that when activated with specific binding to circulating proteins (ligands) triggers a series of intracellular mechanisms that ultimately lead to replication (dividing) cell and tumor growth.

We have drugs (monoclonal antibodies such as cetuximab or tyrosine kinase inhibitors such as Erlotinib and Gefitinib ) able to override this interaction (ligand-receptor) so that the cascade of intracellular mechanisms and cell division is not active. These new drugs for the treatment of esophageal cancer alone, get a 9% objective response (complete and partial responses) and a median survival of seven months. Are being studied in combination with chemotherapy classical or radiotherapy .