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Immunotherapy in the treatment of tumors of the esophagus, gastroesophageal junction and stomach
03/2021 MUDr. Lenka Ostřížková; MUDr. Ivana Kosíková
Tumors of the esophagus, gastroesophageal junction (GEJ) and stomach are the sixth other cause of death. The highest incidence and mortality are in Asia and southern and eastern Africa. However, even in the Czech Republic, the incidence and mortality have an upward trend. In more than half of the patients, the diagnosis is made in the primarily advanced or disseminated stage. Histologically, tumors have squamous cell carcinomas, which mainly affect the proximal two-thirds, and adenocarcinomas, which affect the distal third and the GEJ region. There are more adenocarcinomas in gastric tumors at the same time. Squamous cell carcinomas of the esophagus are predominantly found in the countries of Eastern Europe and Asia. Adenocarcinomas dominate in North America and Western Europe. Anatomical localization, histological type of tumor, evaluation, and extent of the disease (TNM classification) are the cornerstones for determining strategic therapy. Treatment is interdisciplinary and should be conducted through multidisciplinary teams. According to the results of clinical studies, new immunotherapeutic strategies, antibodies against cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and antibodies against programmed cell death protein 1 (PD-1) / programmed cell death-ligand 1 (PD-L1) also have their place in the treatment algorithm of esophageal and gastric tumors. The results of clinical studies have shown that the combination of immunotherapy and chemotherapy improves overall survival and prolongation of time to disease progression compared to chemotherapy alone. Both in the treatment of metastatic disease and in adjuvant administration.
ENTIRE ARTICLE
Tumors of the esophagus, gastroesophageal junction (GEJ) and stomach are the sixth other cause of death. The highest incidence and mortality are in Asia and southern and eastern Africa. However, even in the Czech Republic, the incidence and mortality have an upward trend. In more than half of the patients, the diagnosis is made in the primarily advanced or disseminated stage. Histologically, tumors have squamous cell carcinomas, which mainly affect the proximal two-thirds, and adenocarcinomas, which affect the distal third and the GEJ region. There are more adenocarcinomas in gastric tumors at the same time. Squamous cell carcinomas of the esophagus are predominantly found in the countries of Eastern Europe and Asia. Adenocarcinomas dominate in North America and Western Europe. Anatomical localization, histological type of tumor, evaluation, and extent of the disease (TNM classification) are the cornerstones for determining strategic therapy. Treatment is interdisciplinary and should be conducted through multidisciplinary teams. According to the results of clinical studies, new immunotherapeutic strategies, antibodies against cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and antibodies against programmed cell death protein 1 (PD-1) / programmed cell death-ligand 1 (PD-L1) also have their place in the treatment algorithm of esophageal and gastric tumors. The results of clinical studies have shown that the combination of immunotherapy and chemotherapy improves overall survival and prolongation of time to disease progression compared to chemotherapy alone. Both in the treatment of metastatic disease and in adjuvant administration.