Integration of targeted agents in the neo-adjuvant treatment of gastro-esophageal cancers Journal Article
| Authors: | Power, D. G.; Ilson, D. H. |
| Article Title: | Integration of targeted agents in the neo-adjuvant treatment of gastro-esophageal cancers |
| Abstract: | Pre-and peri-operative strategies are becoming standard for the management of localized gastro-esophageal cancer. For localized gastric/gastro-esophageal junction (GEJ) cancer there are conflicting data that a peri-operative approach with cisplatin-based chemotherapy improves survival, with the benefits seen in esophageal cancer likely less than a 5-10% incremental improvement. Further trends toward improvement in local control and survival, when combined chemotherapy and radiation therapy are given pre-operatively, are suggested by recent phase III trials. In fit patients, a significant survival benefit with pre-operative chemoradiation is seen in those patients who achieve a pathologic complete response. In esophageal/GEJ cancer, definitive chemoradiation is now considered in medically inoperable patients. In squamous cell carcinoma of the esophagus, surgery after primary chemoradiation is not clearly associated with an improved overall survival, however, local control may be better. In localized gastric/GEJ cancer, the integration of bevacizumab with pre-operative chemotherapy is being explored in large randomized studies, and with chemoradiotherapy in pilot trials. The addition of anti-epidermal growth factor receptor and anti-human epidermal growth factor receptor-2 antibody treatment to pre-operative chemoradiation continues to be explored. Early results show the integration of targeted therapy is feasible. Metabolic imaging can predict early response to pre-operative chemotherapy and biomarkers may further predict response to pre-operative chemo-targeted therapy. A multimodality approach to localized gastro-esophageal cancer has resulted in better outcomes. For T3 or node-positive disease, surgery alone is no longer considered appropriate and neo-adjuvant therapy is recommended. The future of neo-adjuvant strategies in this disease will involve the individualization of therapy with the integration of molecular signatures, targeted therapy, metabolic imaging and predictive biomarkers. © The Author(s), 2009. |
| Keywords: | cancer survival; treatment response; overall survival; clinical trial; review; squamous cell carcinoma; sorafenib; bevacizumab; cisplatin; erlotinib; fluorouracil; sunitinib; diarrhea; drug efficacy; drug safety; hypertension; monotherapy; multimodality cancer therapy; skin toxicity; treatment duration; unspecified side effect; capecitabine; paclitaxel; adjuvant therapy; radiation dose; chemotherapy; outcome assessment; colorectal cancer; lymphadenectomy; carboplatin; metastasis; multiple cycle treatment; radiation; etoposide; esophagitis; mucosa inflammation; nausea; dehydration; camptothecin; in vitro study; cetuximab; prediction; cancer mortality; docetaxel; irinotecan; digestive system cancer; rash; preoperative period; celecoxib; thromboembolism; folinic acid; nonsteroid antiinflammatory agent; gefitinib; vandetanib; stomach cancer; epirubicin; taxane derivative; trastuzumab; oxaliplatin; esophagus cancer; esophageal adenocarcinoma; stomach adenocarcinoma; absence of side effects; rectum cancer; stomach carcinoma; esophagus carcinoma; lapatinib; lower esophagus sphincter; esophageal carcinoma; depsipeptide; prinomastat; squamous cell carcinoma of the esophagus |
| Journal Title: | Therapeutic Advances in Medical Oncology |
| Volume: | 1 |
| Issue: | 3 |
| ISSN: | 1758-8340 |
| Publisher: | Sage Publications Ltd. |
| Date Published: | 2009-01-01 |
| Start Page: | 145 |
| End Page: | 165 |
| Language: | English |
| DOI: | 10.1177/1758834009347323 |
| PROVIDER: | scopus |
| PMCID: | PMC3126001 |
| PUBMED: | 21789119 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 30 November 2010" - "Source: Scopus" |
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