Targeted therapy in esophageal cancer

Abstract

Esophageal cancer consists of two distinct histological types, esophageal squamous cell-carcinoma (ESCC) and esophageal adenocarcinoma (EAC). Esophageal carcinoma is a grave malignancy with regards to prognosis and mortality. ESCC remains the dominant histological type of esophageal cancer worldwide, with about 90 percent of all cases worldwide. However, EAC is now much more common in the United States and the Western World, and represents one of the fastest growing cancers there. Despite significant progress in multimodality treatment options, the overall prognosis remains poor, and 5-year survival rates for all-comers are still below 20 percent. Although esophageal cancer initially responds well to systemic therapy, most patients recur and eventually die from their disease. Therefore, new treatment options are urgently needed. The combination of traditional systemic therapy with new biologicals and/or targeted agents is one of these new treatment options. Some of these agents are already approved, while others are currently undergoing clinical trials. These targeted therapies have emerged as an important tool for the treatment of many different cancer types, including esophageal cancer. Herein, we review the recent literature and ongoing clinical trials in esophageal cancer targeted therapies, and discuss the different targeted pathways. Currently, most esophageal cancer patients are still treated with a combination of chemotherapies like taxanes (paclitaxel, docetaxel), platinums (carboplatin, cisplatin), anthracyclines (doxorubicin, epirubicin) or pyrimidine analogs (5-fluorouracil). Future treatment strategies should be based on the molecular features of each patient’s individual tumor, and should include biologicals/targeted agents tailored to these specific findings.