Cancer Treatment Today

For esophageal cancer, bevacizumab is in the early stages of clinical development. Most trials have been limited to GE adenocarcinomas, given the life-threatening hemoptysis described in bevacizumab-treated patients with squamous cell carcinoma of the lung. A multi-center phase II study of irinotecan, cisplatin, and bevacizumab in 20 patients with unresectable or metastatic gastric or GE adenocarcinoma has shown encouraging preliminary results. Shah

The imaging modalities commonly used for the diagnosis and staging of esophageal cancer are upper GI study, endoscopy, endoscopic ultrasound, CT, and PET. PET is superior to CT and EUS combined in diagnosing stage IV disease. NCCN recommends PET for preoperative staging only, not for restaging. While the studies on detection of distant disease suggest better diagnostic performance for PET over CT, the available body of evidence is small. Only one

Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A recent clincial guidelines concluded: " In consideration of the systematic review, external review, and subsequent Practice Guidelines Coordinating Committee revision suggestions, and final approval, the Gastrointestinal Cancer Disease Site Group recommends the

Esophageal cancer, including cancer arising from the gastro-esophageal junction, is a challenging disease worldwide. At diagnosis, approximately 50% of patients present with disease that extends beyond the site of origin in the esophagus. The Radiation Therapy Oncology Group (RTOG) study 85-01 compared treatment with 4 cycles of cisplatin plus 5-FU with radiation therapy (50 Gy in 25 fractions) to radiation therapy (64 Gy in 32 fractions) in patients

The vinorelbine/ cisplatin combination for esophageal cancer is based on Phase II data, more specifically on one phase II study. The authors concluded that, "...vinorelbine and cisplatin in combination constitutes an active regimen for patients with metastatic squamous cell carcinoma of the oesophagus with response rates similar to the better treatment in the previous EORTC randomised study (34% for vinorelbine–cisplatin compared with 35% for cisplatin–5-FU),

Erlotinib has shown activity individually, as single drugs, or in combination with chemotherapy in upper gastro-intestinal cancers, including esophageal and gastro-esophageal adenocarcinomas, gastric cancer and pancreatic cancer. In several recent phase 2 trials,erlotinib appears to be somewhat active in esophageal cancer and not very active in gastric cancer. The authors conclude that additional studies with erlotinib as a single agent and in combination

Lay Summary: Chemotherapy or chemotherapy with radiation are standard of care for esophageal cancer that has not spread. The role of preoperative chemoradiation for esophageal cancer is well established. Two meta-analyses comprised of the results from 15 randomized controlled trials, as well as pooling performed by the Gastrointestinal Cancer Disease Site Group, all detected a statistically significant difference in survival favouring preoperative

There had recently been much evolution in the treatment of esophageal cancer. Among changes has been greater recognition of Xeloda and of Oxapliplatin as effective drugs. Ths isbased on thhREAL trial. The REAL trial enrolled 1,002 patients with locally advanced (inoperable) or metastatic cancer of the esophagus, esophagogastric junction, or stomach. Patients were assigned to one of four treatment groups: ECF (Ellence® (epirubicin), cisplatin, and

More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention of local and distant tumor control, improving quality of life and prolongation of survival. A number of agents have been investigated as sole therapy for esophageal cancer, including cisplatin, irinotecan, bleomycin, mitomycin, 5-fluorouracil, paclitaxel, methotrexate, vinorelbine,

Chemosensitivity assays are controversial but most experts believe that they do not reliably assist in selecting chemotherapy. There is more evidence for chemoresistance assays but this also remains disputed. Chemoresistance assays are a modification that tests resistance to chemo rather than sensitivity. They work on the assumption that if celss show reesistance to very high concentrations of a drug in vitro, they will also be resistant in vivo