What’s New in Esophageal Cancer Research?

Research into the causes, early detection, and treatment of esophageal cancer is now being done at many medical centers, university hospitals, and other institutions around the world.

Genetics

Researchers have found 4 inherited syndromes that raise the risk of esophageal cancer. They have found specific genes related to 3 of these syndromes, and more research is being done. Researchers hope to find additional genes and to come up with more detailed recommendations for screening to find esophageal cancer early in people at high risk because of these syndromes.

Tests

Endoscopic biopsy

In recent years, a new method called wide-area transepithelial sampling with computer assisted 3-dimensional analysis (WATS3D) has been shown to improve detection of pre-cancers, when used in conjunction with the traditional biopsy method. In the traditional biopsy method, forceps are used to take multiple (6-8) biopsy samples, which are placed on slides for the pathologist to examine under the microscope. With WATS3D, a brush is used to collect samples from across a larger area and the cells are interpreted by a computer to form a 3-D picture. This picture is then reviewed by pathologist. Many centers are using this technique. However, more research is needed and studies from larger clinical trials are on-going.

Liquid biopsy

Researchers are studying liquid biopsies for cancer screening, diagnosis, and treatment. Most liquid biopsies are done using a sample of blood, but samples of urine, spinal fluid, or pleural effusions (fluid around the lungs) can also be used. It is much easier to get a sample of blood for testing than to get a sample of the tumor with a needle, and studies have shown that liquid biopsies do contain tumor cells as well as pieces of DNA from the tumor.

Current research is testing esophageal cancer DNA from liquid biopsies to find specific mutations. Researchers are hoping to find out if the gene changes could help doctors choose the best drugs for patients. Studies are also looking at whether the liquid biopsy tumor DNA can help predict how the tumor might respond to certain drugs, or how likely it might be to come back after treatment.

Imaging tests

Currently, people with esophageal cancer who get chemo or chemoradiation before surgery (neoadjuvant treatment) will have another imaging test after treatment to find out whether the tumor has gotten small enough to do surgery. Researchers are studying if a PET scan can help doctors decide the next step in treatment. For example, should people who were treated with neoadjuvant chemotherapy whose PET scans still show signs of cancer be treated with radiation therapy or a different chemotherapy to try and shrink the cancer more before getting surgery?

Treatment

Chemotherapy

Many studies are testing what the best order of treatment is for esophageal cancer. Around the world, different combinations of treatment are used. Studies are looking to see if one combination is better than the other. For example, is chemotherapy better than chemoradiation? Is chemotherapy or chemoradiation better if given before surgery or after surgery? Do certain chemo drugs work better with radiation than others to shrink the tumor?

Immunotherapy and Targeted Therapy

Immunotherapy drugs known as checkpoint inhibitors are useful in some other cancers and are now coming into use for esophageal cancer. For example, the drug pembrolizumab (Keytruda) is approved to treat some advanced cancers of the esophagus and gastroesophageal junction. Targeted therapy with drugs such as trastuzumab and ramucirumab is also approved for treatment of advanced esophageal cancer.

There are studies now looking at using immunotherapy or targeted therapy drugs with or without chemotherapy before or after surgery in patients with potentially curable cancers to see if tumors will shrink more or have less of a chance of coming back.