Abdo Joe, Bertellotti Carrie A, Cornell David L, Agrawal Devendra K, Mittal Sumeet K
Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE, United States.
Department of Surgery, CHI Health Creighton University Medical Center, Omaha, NE, United States.
Front Oncol. 2017 Jul 18;7:151. doi: 10.3389/fonc.2017.00151. eCollection 2017.
There has been an alarming rise in the incidence of esophageal adenocarcinoma which continues to have poor survival rates primarily due to lack of effective chemotherapy and presentation at advanced stages. Over a dozen chemotherapeutic agents are FDA approved for esophageal cancer (EC), and a two or three-drug combination is typically prescribed as first-line therapy for the majority of EC patients, administered either pre or post-operatively with esophageal resection. We have noticed significant variability in adjuvant and neoadjuvant regimens used in the community setting. The aim of this study was to review the various drug regimens used in the neoadjuvant setting for EC patients with adenocarcinoma undergoing resection at a single tertiary referral center in the Midwest. A total of 123 patients (stage II-III) underwent esophageal resection after neoadjuvant treatment at the center. Overall, 18 distinct drug regimens were used in 123 patients including two patients who received targeted therapy. Median survival post-surgery for this group was 11.2 months with no single regimen offering a survival advantage. These results reveal an unclear algorithm of how accepted regimens are prescribed in the community setting as well as a dire need for agents that are more effective. Additionally, it was noted that although proteomic markers have been found to predict drug response to 92% of the FDA-approved drugs in EC (12 of 13), according to pathology reports, molecular diagnostic testing was not used to direct treatment in this cohort. We therefore propose potential strategies to improve clinical outcomes including the use of a robust molecular oncology diagnostic panel and discuss the potential role for targeted chemotherapy and/or immunotherapy in the management of EC patients.
食管腺癌的发病率出现了惊人的上升，主要由于缺乏有效的化疗以及晚期发病，其生存率仍然很低。十几种化疗药物已获美国食品药品监督管理局（FDA）批准用于食管癌（EC），大多数EC患者通常采用两药或三药联合作为一线治疗方案，在食管切除术前或术后使用。我们注意到社区环境中使用的辅助和新辅助治疗方案存在显著差异。本研究的目的是回顾在中西部一个单一的三级转诊中心，对接受手术切除的腺癌EC患者在新辅助治疗中使用的各种药物方案。共有123例（II - III期）患者在该中心接受新辅助治疗后进行了食管切除术。总体而言，123例患者使用了18种不同的药物方案，其中包括2例接受靶向治疗的患者。该组患者术后的中位生存期为11.2个月，没有单一方案显示出有生存优势。这些结果揭示了在社区环境中如何开具公认方案的算法尚不清楚，以及迫切需要更有效的药物。此外，还注意到尽管已经发现蛋白质组学标志物可预测EC中92%的FDA批准药物的药物反应（13种中的12种），但根据病理报告，该队列中未使用分子诊断检测来指导治疗。因此，我们提出了改善临床结果的潜在策略，包括使用强大的分子肿瘤学诊断 panel，并讨论靶向化疗和/或免疫疗法在EC患者管理中的潜在作用。
