A new viable option for advanced esophageal cancer

The esophageal cancer occurs in the esophagus, a long hollow tube that runs from your throat to your stomach. Why do we need the esophagus? Because helps to move the food you swallow from the back of your throat to your stomach to be digested. The esophageal cancer can occur at any part along the esophagus. More common in men than women and is the sixth most common cause of death worldwide.

It is difficult to diagnose because in early stages commonly doesn’t show symptoms nor signs. Some of them, may include: dysphagia, weight loss, chest pain or pressure, worsening indigestion and coughing. We recommend make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

Since this disease is more difficult to diagnose in early stages, it is more common to detect when has already made metastasis. Chemotherapy is the standard second-line therapy for people with advanced cancer and has limited benefit for many patients, as well as many significant side effects. The side effects will depend on the individual and dose used, that may include fatigue, risk of infection, nausea, vomiting, hair loss and diarrhea. When the patients have progressed after standard therapy, there are only few treatments options. One main reason is because there has been limited progress in finding molecular alterations in tumors that might make goods targets for treatment. In an effort to increase the treatment options for patients with advanced esophageal cancer, researches were investigating whether any immunotherapy can work for these patients.

Recently has been approved Pembrolizumab as a new viable option for advanced esophageal cancer. In this year, the Food and Drug Administration (FDA) has approved the immunotherapy drug Keytruda® (Pembrolizumab) to treat patients with locally advanced or metastatic squamous cell carcinoma of the esophagus (ECC). In order a patient is suitable to receive treatment must have much higher levels of the protein PD-L1 in their tumors (a score of 10 or greater). This approval means an important advance because it provides another agent for patients who have a disease with poor outcomes and has better benefits in some patients and some of them, responded to pembrolizumab for extended periods. KEYNOTE-181 and KEYNOTE-180 are two trials sponsored by the drug’s manufacturer, Merck, that studied the benefits and side effects of this novel immunotherapy. KEYNOTE-181 is a phase 3 trial of 628 patients whom their advanced esophageal cancer progressed after one line of treatment and the KETNOTE-180 was a phase 2 trial that enrolled 121 patients with advanced esophageal cancer that had progressed after two or more lines of standard therapy. Both studies showed an overall response rate that were between 20% and 22%, and that response was often relatively long-lasting. In the other hand, in the KEYNOTE-180, was reported that 15 patients had treatment related grade 3 to 5 adverse events.

This represents a novel approach and incredible benefit because now doctors can see the PD-L1 score and tell to their patients whether they will benefit more or less from pembrolizumab than chemotherapy, without the effects of the last one.

Here in Althian, we have several protocols that use immunotherapy as first line of treatment for many advanced cancers. They have shown promising results, with lower rates of adverse events, as well, those patients who have adverse events considered critical were treated correctly. We have plenty experience with these types of protocols. Contact us and we will be more than happy to assist you.