Abstract
Gastrointestinal (GI) malignancies (esophageal, gastric, pancreatic, intra- and extra-biliary ductal, hepatocellular, and colorectal cancers) are an important cause of cancer incidence and mortality in the US and globally. GI cancers account for 15.4% and 23.8% of incident cancers and cancer-related deaths respectively in the US alone. Although earlier diagnosis and treatment advances have improved outcomes for some GI malignancies, the need for improved therapies in all disease phases (adjuvant, neoadjuvant and advanced) is paramount. Utilization of monoclonal antibodies targeting against vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) has shown the success in selected colorectal carcinoma patients. More investigations of immunotherapy are on going in the treatment of GI malignances with different mechanisms and methods. In this article, we review data for established and evolving immunotherapy-related treatment options in GI malignancies.
Highlights
Gastrointestinal (GI) malignancies refer to malignant neoplasms of the GI tract and accessory organs of digestion system: esophagus, stomach, liver and biliary system, pancreas, small intestine, colon and rectum, appendix and anus
Since agents targeting both epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) have gained regulatory approval for KRAS/NRAS wild type (WT) mCRCpatients, the sequence of application of either agent has been in debate
In KRAS/NRAS WT patients who received 1st line EGFR inhibition, this is typically not continued at the time of progression as cross-resistance is assumed given the similar mechanisms of action
Summary
Gastrointestinal (GI) malignancies refer to malignant neoplasms of the GI tract and accessory organs of digestion system: esophagus, stomach, liver and biliary system, pancreas, small intestine, colon and rectum, appendix and anus. GI malignancies account for more incident cases and deaths than any other organ system. These cancers are highly disparate: involving tumors of various histological types The primary intently curative treatment option for most GI malignancies is still surgical resection though combined modality therapy (concurrent chemotherapy and radiotherapy) has equivalent outcomes in anal cancer. Unlike melanoma and renal cell cancer in which immunotherapeutic options were a focus of early efforts, similar approaches in GI malignancies have only recently been exploited likely secondary to early successes with cytotoxic chemotherapy. We broadly delineate the various immunotherapeutic options that have been or are explored in GI malignancies
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