Emerging drugs for esophageal cancer.
BACKGROUND
Cancer of the esophagus and gastro-esophageal junction is a disorder with a poor prognosis and increasing incidence.


OBJECTIVE
To provide a critical evaluation of current treatment strategies and new developments including targeted therapy for esophageal cancer.


METHODS
Published clinical trials as well as abstracts were selected regarding chemoradiation or targeted therapy for esophageal cancer.


CONCLUSIONS
Preoperative chemotherapy may offer a survival advantage compared to surgery alone, but the evidence is inconclusive. For preoperative chemoradiation, only 2 of 10 randomized trials showed advanced survival compared to surgery alone, and, therefore, more Phase III trials and, consequently, meta-analyses are needed. Until now, for palliative chemotherapy, no survival benefit has been shown. This is largely due to a lack of studies and difficulties in performing randomized trials. The application of targeted therapy is widespread and reported for several tumor types. For esophageal cancer, most studies have been performed with EGFR inhibitors, including cetuximab, gefitinib, erlotinib and trastuzumab. Limited experience is available with angiogenesis inhibitors, apoptosis inhibitors and COX-2 inhibitors. As yet, targeted therapies are proven to be safe often in combination with chemoradiation, but modestly effective for esophageal cancer. Phase III trials have not been published yet and, therefore, for targeted therapies also, possibly using new concepts, more studies are needed.
Homs
Marjolein Y V
MY
University Medical Center Utrecht, Department of Medical Oncology, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Voest
Emile E
EE
Siersema
Peter D
PD
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000639:trends; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D016503:Drug Delivery Systems; D015507:Drugs, Investigational / Q000627:therapeutic use*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D010166:Palliative Care / Q000706:statistics & numerical data
D020533:Angiogenesis Inhibitors; D052246:Cyclooxygenase 2 Inhibitors; D015507:Drugs, Investigational; D066246:ErbB Receptors