Esophageal Cancer

The addition of lapatinib to capecitabine/oxaliplatin did not prolong overall survival among patients with previously untreated HER2-amplified gastroesophageal adenocarcinoma.

This comprehensive guide for oncologists covers the diagnosis, staging, treatment, and management of esophageal cancer.

Long-term results of the CROSS study have confirmed that neoadjuvant chemoradiotherapy added to surgery should be the standard of care in esophageal or esophagogastric junction carcinoma.

A retrospective analysis found that high expression levels of two angiogenic factors were associated with poor prognosis in esophageal cancer.

The FDA approved ramucirumab (Cyramza) in combination with paclitaxel for treating patients with advanced gastric or gastroesophageal junction adenocarcinoma.

Measuring expression of several microRNAs were significantly predictive of complete pathologic response to treatment in patients with esophageal adenocarcinoma.

The stage of esophageal adenocarcinomas after neoadjuvant chemotherapy is predictive of outcomes, rather than the stage determined prior to therapy.

New research has identified specific gene mutations that occur in precancerous esophageal lesions, a finding which was then put into use with a simple non-endoscopic test.

Neoadjuvant chemoradiotherapy did not improve resection rates or survival outcomes in patients with early-stage, locally advanced esophageal cancer.

Preoperative staging of esophageal cancer with PET/MR is approximately as good as with endoscopic ultrasound, and may improve slightly over ultrasound and PET/CT scans, according to a new study.

Until anatomic staging and physiologic prediction models improve, induction therapy serves as a useful crutch that can mitigate the weaknesses in both of these important preoperative tasks.

Both esophageal cancer and stomach cancer are aggressive malignancies with contrasting risk factors, histologies, and molecular characteristics-yet for the most part comparable therapeutic approaches.

The purpose of this review is to update, present some of the new data on, and outline the controversies regarding neoadjuvant and adjuvant therapy of esophagogastric junction and gastric adenocarcinoma.

Adding ramucirumab to FOLFOX did not delay progression in patients with untreated advanced gastric or esophageal adenocarcinoma, according to trial results presented at the 2014 ASCO Annual Meeting.

Patients who exhibited certain clusters of symptoms after undergoing surgery for esophageal cancer were at an increased risk for mortality, according to the results of a prospective Swedish cohort study.

A meta-analysis by researchers in Australia shows that those infected with the human papillomavirus have a threefold higher risk of developing esophageal squamous cell carcinoma.

Adding the chemotherapy docetaxel to active symptom control in advanced esophagogastric adenocarcinoma improves survival of patients. These are the results of the phase III COUGAR-02 trial.

Three papers published today show that aspirin, taken daily, may prevent cancer, and could even treat certain cancers.

Esophageal cancer generally has a poor prognosis; while preoperative chemotherapy is recommended, tumors often do not respond to treatment.

Recent developments in the epidemiology, staging, and treatment of esophageal and gastroesophageal junction cancers have led to significant changes in the way these malignancies are managed. Although a relationship between gastroesophageal reflux disease and esophageal cancer has been demonstrated, antireflux surgery has been shown to have no preventive effect with regard to the development of esophageal adenocarcinoma. The newly modified staging system of the World Esophageal Cancer Consortium has helped define the optimal number of lymph nodes to dissect during an esophagectomy. Incorporating modern techniques, such as esophageal ultrasound, fine needle aspiration, and positron emission tomography, can improve the prognostic value of staging. Use of higher-volume centers and higher-volume surgeons for the performance of procedures in upper gastrointestinal cancers is associated with better outcomes. Neoadjuvant chemoradiation using a wide variety of chemotherapy regimens appears to have become the new standard of care for stage II and III esophageal cancer.

Esophageal adenocarcinoma (EAC) affects approximately 11,000 persons per year in the United States, is increasing in incidence, and is associated with an exceptionally high mortality rate.[1-4] In this issue of ONCOLOGY, Krasna reviews the role of multimodality therapy in the treatment of EAC. Poor outcome in patients with EAC is reflective of both deficiencies in early detection and the inadequacy of available therapies across stages.

Dr. Krasna has written an overview of multimodality therapy in esophageal cancer, with a particular focus on aspects related to staging and surgical care. The optimal management of locally advanced esophageal cancer remains a subject of controversy and active debate. However, there is now a clear consensus that surgery alone is inadequate therapy for patients with T3 or node-positive disease.

Esophagitis is a known adverse effect of bisphosphonate use and reflux esophagitis is an established risk factor for esophageal cancer through the Barrett pathway.

Although still relatively uncommon in Western countries, esophageal cancer is fatal in the vast majority of cases. In the United States, an estimated 16,470 new cases will be diagnosed in the year 2009, and 14,530 deaths will result from the disease. This high percentage of deaths rivals that of pancreatic cancer and is more than four times that of rectal cancer.

Gastric cancer is more common than esophageal cancer in Western countries but is less fatal. More than 21,130 new cases of gastric cancer will be diagnosed in the United States in the year 2009, with 10,620 deaths expected. Worldwide, gastric cancer represents approximately 930,000 new cases and accounts for more than 700,000 deaths. The incidence and mortality of gastric cancer have been declining in most developed countries, including the United States; the age-adjusted risk (world estimate) fell 5% from 1985 to 1990.

Turmeric, or curcumin (diferuloylmethane), may be a favorable agent for the prevention and treatment of esophageal cancer, according to researchers at the Cork Cancer Research Center and Mercy University Hospital in Cork, Ireland. The authors noted that turmeric was able to induce cell death by a mechanism that is not reliant on apoptosis induction.

BARRX Medical, Inc, a global technology leader in treating Barrett's esophagus, announced the publication of two related European trials that report a 100% eradication rate for early esophageal cancer and precancerous dysplasia using endoscopic resection followed by ablation therapy with the HALO ablation system. Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) and is a known risk factor for esophageal cancer, the fastest growing cancer in the Western world.

The use of neoadjuvant chemotherapy in resectable esophageal cancer was bolstered by the results of two trials presented at the 2008 Gastrointestinal Cancers Symposium.

Extracts of black raspberries might protect Barrett's esophagus patients against esophageal cancer and also might shift premalignant oral lesions from progression to squamous cell carcinoma (SCC) back toward normal differentiation

Data published in the New England Journal of Medicine show that oral capecitabine (Xeloda) and oxaliplatin (Eloxatin) in combination with epirubicin (Ellence) is a comparable alternative to infused fluorouracil (5-FU) and cisplatin with epirubicin in patients with previously untreated, advanced esophagogastric cancer.