Multimodality approaches to control esophageal cancer: development of chemoradiotherapy, chemotherapy, and immunotherapy
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REVIEW ARTICLE
Multimodality approaches to control esophageal cancer: development of chemoradiotherapy, chemotherapy, and immunotherapy Yoshihiro Kakeji1 · Taro Oshikiri1 · Gosuke Takiguchi1 · Shingo Kanaji1 · Takeru Matsuda1 · Tetsu Nakamura1 · Satoshi Suzuki1 Received: 19 May 2020 / Accepted: 15 September 2020 © The Japan Esophageal Society 2020
Abstract Esophageal cancer has a poor prognosis despite the fact that surgical techniques have been advanced and optimized, and systemic multimodality approaches have progressed recently. Adding chemotherapy, radiotherapy, and immunotherapy to the basic surgical approach have been shown to have therapeutic benefit for esophageal cancer. This review describes the latest development of chemoradiotherapy, chemotherapy, and immunotherapy, which have contributed to the reduction in esophageal cancer growth and improved the survival of patients. Chemoradiation is a treatment option for resectable esophageal cancer to preserve the esophagus for patients who cannot tolerate surgery. Moreover, a combination of chemoradiotherapy and salvage surgery could extend the survival of patients. The effects of a triplet chemotherapy regimen are currently being verified in some Phase III studies for unresectable advanced/recurrent esophageal cancer. In addition, with the great promise of immune checkpoint inhibitors, strategies that incorporate the use of immunotherapy may shift from the metastatic setting to the neoadjuvant/adjuvant setting as a result of clinical trials. More precise comprehension of the molecular biology of esophageal cancer is expected to further control disease progression using multimodality treatments in the future. Keywords Esophageal cancer · Surgery · Chemoradiotherapy · Chemotherapy · Immunotherapy
Introduction Esophageal cancer is the seventh most common cancer and the sixth leading cause of cancer-related deaths worldwide [1]. Esophageal Cancer Practice Guidelines 2017, edited by the Japan Esophageal Society [2, 3], provide general clinicians with information to guide them to make informed choices of the available diagnosis/treatment strategies for esophageal cancer. Surgery forms a mainstay of treatment for esophageal cancer, while chemotherapy, radiotherapy, and immunotherapy also have therapeutic effect. Tanaka et al. [4] reviewed recent advances in esophageal cancer treatment in Japan, while Seto [5] updated the field of esophageal cancer surgery by reviewing the most recent key papers. In recent years, several well-conducted randomized clinical trials have demonstrated that multidisciplinary management * Yoshihiro Kakeji [email protected]‑u.ac.jp 1
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7‑5‑2 Kusunoki‑cho, Chuo‑ku, Kobe 650‑0017, Japan
with chemoradiation or chemotherapy for esophageal cancer improve survival outcome. In addition, immune checkpoint inhibitors have emerged as a therapeutic option in the advanced or metastatic setting. We herein reviewed recent key evidence of multimo
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