Esophageal cancers are increasingly common, and are associated with poor patient prognosis. They are typically diagnosed at advanced tumor stages, after esophagus or esophagogastric obstruction has become symptomatic. Presentations at the 2013 Gastrointestinal Cancers Symposium in San Francisco included new phase 3 trial evidence for the second-line utility of docetaxel in advanced esophageal adenocarcinoma, promising phase 2 study survival outcomes for rilotumumab in metastatic gastric and gastroesophageal cancers, new guidance on HER2 testing modalities, and reviews of the available evidence for neoadjuvant and targeted therapies in development or already in use against these deadly malignancies.
Squamous cell and adenocarcinoma esophageal cancers represent a challenging, highly lethal, and increasingly common disease. Incidence rates of esophageal adenocarcinoma are among the fastest-growing of any cancer type for Caucasian men and women.1,2 An estimated 17,460 Americans (13,950 men and 3,510 women) were diagnosed with esophageal cancer in 2012, and 15,070 patients are estimated to have died that year.3 Esophageal cancers are associated with tobacco and heavy alcohol use, Barrett’s esophagus, older age, and African-American ethnicity; and as noted above, they are more common among men than women.4
These cancers typically are diagnosed only after tumors are advanced enough to cause symptomatic luminal obstruction, so most patients present with advanced-stage disease.1 More than half of patients are diagnosed with locoregionally advanced or metastatic esophageal cancer (Table 1).3 Presenting symptoms most commonly include difficulty or painful swallowing, hoarseness with cough, heartburn and indigestion, chest pain, and weight loss, according to the National Cancer Institute (NCI).4
Table 1. Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for 2002-2008, All Races, Both Sexes
|Stage at Diagnosis||Stage Distribution (%)||5-year Relative Survival (%)|
|Localized (confined to primary site)||22||37.8|
|Regional (spread to regional lymph nodes)||30||19.8|
|Distant (cancer has metastasized)||35||3.4|
Source: US National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) Stat Fact Sheet: Esophagus. http://seer.cancer.gov/statfacts/html/esoph.html. Accessed Jan. 24, 2013.
Presenters at the 2013 Gastrointestinal Cancers Symposium, held on January 24-26 in San Francisco, CA, described preclinical and clinical research that will help shape esophageal cancer management in the years to come, and addressed persisting clinical and research challenges.