Modern concepts of systemic treatment for adjuvant and palliative treatment of locally advanced or metastasized esophageal cancer

Abstract

The approval of awide variety of PD-1/PD-L1 and CTLA‑4 inhibitors has sustainably influenced the treatment landscape in many tumor entities and established immunotherapy as anew oncological treatment strategy. This article summarizes the current clinical state of treatment for locally advanced and metastatic esophageal cancer and assesses the running and future developmental program and the implementation in the clinical routine. Publications from Medline, ASCO and ESMO were systematically collected and evaluated. Many phaseI-III trials focusing on immunotherapy for gastrointestinal tumors were carried out in recent years but were however without comparable success to other tumor entities and with only moderate response rates between 10% and 25% in monotherapy. Subgroups such as microsatellite instability (MSI) cancers and tumors overexpressing PD-L1 seem to particularly benefit from treatment with immune checkpoint inhibitors. Routine testing for known molecular alterations should therefore be carried out with all advanced esophageal cancers. Initial promising approaches with a combination of chemotherapy and immunotherapy were recently published and could become new treatment standards for esophageal cancer. Due to the survival advantage with a combination of chemotherapy and immunotherapy for untreated advanced stage esophageal cancer, it seems likely that this treatment strategy will become established as anew standard of care, assuming approval is granted. Immunotherapy might also become important in the adjuvant treatment of esophageal cancer.