Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, USA.
Curr Opin Gastroenterol. 2019 Jul;35(4):337-343. doi: 10.1097/MOG.0000000000000542.
The management of esophageal cancer has not changed significantly over the last decade. Survival rates remain poor in locally advanced and metastatic disease. Newer treatment modalities are desperately needed if we are to improve 5-year overall survival rates. Immunotherapeutic strategies hold great promise, but a much greater understanding of the immune microenvironment underlying squamous cell and esophageal adenocarcinoma is needed if we are to exploit the inherent cancer fighting capabilities of each patient's immune system.
Here we describe current and future predictive biomarkers, provide a synopsis of the most significant trial results to date, and explain pivotal ongoing phase III trials.
Recent findings suggest that esophageal squamous cell carcinoma may be more sensitive to single agent PD-1 inhibition than esophageal adenocarcinoma, and selecting patients according to PD-L1 combined positive score (CPS) of at least 10 or more may predict higher response rate. We await data indicating the optimal immuno-oncology (IO-IO) combinations that will allow more patients to respond, however it is likely that personalized immunotherapy may be required for the majority. At the present time, it is hoped that chemotherapy combined with PD-1 inhibition will be an optimal strategy, but we await confirmation from soon-to-be published phase III trials.
在过去的十年中，食管癌的治疗并未发生显著变化。局部晚期和转移性疾病的生存率仍然较差。如果要提高 5 年总生存率，则迫切需要新的治疗方法。免疫治疗策略具有很大的潜力，但是如果要利用每个患者免疫系统固有的抗癌能力，则需要对鳞状细胞癌和食管腺癌的免疫微环境有更深入的了解。
在这里，我们描述了当前和未来的预测性生物标志物，概述了迄今为止最重要的试验结果，并解释了关键的正在进行的 III 期试验。
最近的发现表明，与食管腺癌相比，食管鳞状细胞癌可能对单药 PD-1 抑制更为敏感，并且根据 PD-L1 联合阳性评分（CPS）≥10 选择患者可能预测更高的反应率。我们正在等待数据表明哪种免疫肿瘤学（IO-IO）联合治疗方案最有效，但是大多数患者可能需要个性化的免疫治疗。目前，希望化疗联合 PD-1 抑制将是一种最佳策略，但我们正在等待即将发表的 III 期试验的结果确认。
