The Next Era of Esophageal Cancer Treatment: Biomarkers, Immunotherapy, and Personalized Care
Yplostylia Varkonin 
Research continues to evaluate new approaches to cancer diagnosis and treatment. As well as established treatments such as surgery, chemotherapy and radiotherapy, an increasing number of cancer patients are receiving treatment using new approaches that are based on the biological characteristics of the tumor. This includes the use of biomarkers to help diagnose and treat individual patients with the most suitable forms of treatment, including the growing number of cancer patients who are receiving immunotherapy.
These emerging treatment strategies do not necessarily replace current therapies, such as surgery, chemotherapy, and radiation, for patients with esophageal cancer. Rather, they will allow healthcare providers to decide treatment selection based on individual clinical characteristics. As knowledge of esophageal cancer increases, individualized treatment will become a standard practice for this group of patients.
As scientific understanding of esophageal cancer is continually enhanced through research, additional therapies are being evaluated and incorporated into clinical practice for selected patients. This article explains the contribution that biomarkers, immunotherapy and personalized treatment programs are delivering for people with cancer of the esophagus.
Understanding Esophageal Cancer
There are several forms of cancer that can affect the esophagus, including esophageal adenocarcinoma and esophageal squamous cell carcinoma. Both cancer types develop when abnormal cells in the esophagus grow uncontrollably and may invade surrounding tissues and spread to other parts of the body.
The two primary types of esophageal cancer are:
Adenocarcinoma
Adenocarcinoma is the form of esophageal cancer that occurs most frequently in the lower part of the esophagus, near the stomach. Long-standing GERD and Barrett’s esophagus are two of the most significant risk factors for this form of cancer. Barrett’s esophagus is a pre-cancerous change in the lining of the lower esophagus, caused by chronic exposure to stomach acid.
Squamous Cell Carcinoma
Squamous Cell Carcinoma typically occurs in the upper/middle part of the esophagus. While there are a variety of factors that can increase the risk of developing squamous cell carcinoma, the use of tobacco and heavy alcohol consumption have been associated with an increased risk of this disease. In addition, there are certain dietary and environmental factors that have been associated with an increased risk of this disease as well.
There are several types of cancer. It is very important to know the exact type of cancer as treatment can vary depending on the tumor. In most cases, squamous cell carcinoma and adenocarcinoma are the two main types of cancer in the esophagus.
How Esophageal Cancer Treatment Is Evolving
While the location and stage of a tumor continue to play important roles in esophageal cancer treatment, many of today’s treatment decisions also consider a cancer’s molecular features, as well as the overall health, nutritional status, and other clinical factors of a patient.
Modern treatment planning may include evaluation of:
- Cancer stage
- Tumor location
- Histological subtype
- Biomarker test results
- Overall health
- Existing medical conditions
- Nutritional status
- Patient preferences
With this approach, treatment can be given on an individual basis.
Understanding Biomarkers
Biomarker testing in esophageal cancer, including in late stage or advanced disease, is increasingly used in treatment of patients with esophageal cancer. Biomarkers may provide information about tumor characteristics and can help inform treatment planning in some clinical settings.
Laboratory testing may evaluate:
- Protein expression
- Genetic alterations
- Molecular characteristics of tumor cells
- Other biological markers associated with cancer growth
While not every patient will have biomarkers that influence treatment decisions, for many individuals with advanced esophageal cancer, biomarker testing has become an important part of their care.
Why Biomarker Testing Matters
Biomarker testing for esophageal cancer treatment can help a healthcare professional better understand the biological behavior of an individual’s cancer.
Depending on the clinical situation, biomarker testing may assist with:
- Identifying potential treatment options
- Determining eligibility for certain therapies
- Supporting individualized treatment planning
- Guiding discussions about clinical trials
Test results are combined with the patient’s medical history, the stage of the cancer, and the type of therapy the patient has previously received.
The Expanding Role of Immunotherapy
Immunotherapy has become one of the most active areas of research in modern oncology. Unlike classic cancer treatments, such as chemotherapy or targeted therapies that directly attack cancer cells, immunotherapy enables the body’s own immune system to better recognize and fight cancer cells. For certain patients with advanced or metastatic esophageal cancer, immunotherapy may be considered depending on:
- Biomarker testing results
- Disease stage
- Previous treatments
- Overall clinical condition
Research is ongoing to find ways to use immunotherapy in different clinical situations, both as a single agent and in combination with other anticancer therapies.
Personalized Treatment Planning
Opposed to a one-size-fits-all approach, personalized care takes into account the individual characteristics of each patient. Healthcare professionals consider multiple factors before recommending treatment, including:
- Type of esophageal cancer
- Cancer stage
- Tumor biology
- Biomarker findings
- General health
- Nutritional needs
- Existing medical conditions
- Individual treatment goals
Current Esophageal Cancer Treatment Options
Modern esophageal cancer treatment is often a combination of different therapies.
Surgery
Localised disease is often treated with surgery. An esophagectomy is a surgery to remove part of the esophagus. The remaining portion of the esophagus is then connected to the stomach, and the recovery timelines vary among patients following surgery. Advances in minimally invasive surgical techniques and in pre- and post-operative care have made a considerable number of patients candidates for surgical treatment.
Radiation Therapy
This treatment uses high-energy radiation to target cancer cells and help manage disease. It may be used:
- Before surgery
- Together with chemotherapy
- After surgery in selected situations
- To help relieve symptoms in advanced disease
Plans are now made for delivering radiation in the most accurate way and to protect healthy tissues surrounding the cancer.
Chemotherapy
Chemotherapy is the use of medications given by mouth, vein, or injection to destroy cells that are dividing rapidly.
Treatment may be provided:
- Before surgery
- After surgery
- Alongside radiation therapy
- For advanced or metastatic disease
This includes several clinical factors that are taken into account for the individual patient.
Targeted Therapy
The role of targeted therapies is to interfere with the molecular pathways that support the growth of cancer. For specific patients with particular tumors expressing certain biological features that can be identified by lab testing, these therapies are offered as an alternative to the typical approaches to cancer treatment.
Immunotherapy
Immunotherapy becomes an additional treatment option for some patients. Eligibility for immunotherapy depends on a number of clinical factors including biomarker status, stage of cancer and number of previous treatments.
Importance of Multidisciplinary Care
Multidisciplinary approach is increasingly being used for treatment of esophageal cancer. Treatment planning may involve collaboration among:
- Surgeons
- Medical oncologists
- Radiation oncologists
- Gastroenterologists
- Radiologists
- Pathologists
- Nutrition specialists
- Nurses
- Supportive care professionals
By working together in the treatment of esophageal cancer patients, all specialists bring their expertise to the individualized care of each patient.
Ongoing Research and Future Directions
New information is being developed to treat patients with esophageal cancer. Current areas of investigation include:
- Improved biomarker discovery
- New immunotherapy combinations
- Additional targeted therapies
- Earlier disease detection
- Precision medicine strategies
- Improved surgical techniques
- Enhanced supportive care
Ongoing research could reveal new treatment options in the future.
Key Takeaways
Esophageal cancer is treated based on the biological characteristics of the individual’s cancer. As a result, even established therapies like surgery, as well as chemotherapy and radiation, are going to be tailored. Additionally, emerging therapies, including those based on immunotherapy, as well as those that are tested using biomarker testing, are going to become more common and may be considered in selected patients depending on clinical circumstances.
Emerging therapies are not necessarily suited for every patient with esophageal cancer. However, ongoing research on the disease will lead to better knowledge and possibly new treatment options. Treatment options should be discussed with a qualified healthcare professional based on individual clinical circumstances.
