Systemic treatments for resectable carcinoma of the esophagus

Abstract

One of the most prevalent malignancies in the world is esophageal cancer (EC). The 5-year survival rate of EC remains pitiful despite treatment advancements. Neoadjuvant chemoradiotherapy in conjunction with esophagectomy is the standard of care for patients with resectable disease. The pathological complete response rate, however, is not acceptable. A distant metastasis or a locoregional recurrence will occur in about half of the patients. To increase the clinical effectiveness of therapy, it is consequently vital to investigate cutting-edge and potent therapeutic modalities. The approach to the management of resectable EC using immunotherapy has been considerably altered by immune checkpoint inhibitors. Systemic immunotherapy has recently been shown to have the potential to increase the survival of patients with resectable EC, according to growing clinical data. A combination of chemotherapy, radiation, and immunotherapy may have a synergistic antitumor impact because, according to mounting evidence, these treatments can stimulate the immune system via a number of different pathways. In light of this, it makes sense to consider the value of neoadjuvant immunotherapy for patients with surgically treatable EC. In this review, we clarify the rationale for neoadjuvant immunotherapy in resectable EC patients, recap the clinical outcomes of these approaches, go through the upcoming and ongoing investigations, and emphasize the difficulties and unmet research requirements.

Keywords: Systemic treatment; Resectable carcinoma of the esophagus; Personalized medicine; Biomarkers; Chemotherapy; Chemoradiotherapy; Immunotherapy; Immune checkpoint inhibitors

Core Tip: Despite improvements in neoadjuvant and adjuvant treatment approaches in recent years, the average life expectancy of patients with resectable esophageal cancer (EC) still falls below 5 years. Immunotherapy has been effectively used as a first-line therapy for many oncological diseases at advanced stages for over ten years. Immunotherapy drugs are also making great progress in resectable situations, while it is still debatable whether this treatment should be limited to a certain patient subgroup based on biomarker selection. In order to treat resectable EC, immunotherapy, in particular immune checkpoint inhibitors, has made significant strides. This review also provides a brief overview of potential ongoing clinical studies.