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Molecular Profiling Gastro and Esophageal Cancers

Patients with gastric and esophageal cancers may have their tumors tested for three important biomarkers: HER2, MSI, and PD-L1. All three biomarkers can indicate cancer that is targetable and treatable by non-chemotherapy drugs that are already available and known to be effective.

 

First Line Therapy Options Stage 4 Gastric and Esophogeal Cancers

FOLFOX and CAPOX are the two primary chemotherapy regimens used in the first line setting of stage 4 gastric and esophageal cancer treatment. FOLFOX and CAPOX differ in frequency of dosing, however, both are typically very well tolerated with few side effects.

Second-Line Regimen Treatment Options Gastroesophageal Junction Cancers

Second line treatment options for gastroesophageal junction cancers can range from single-drug therapy to a more aggressive double-drug therapy. The most aggressive therapy regimen is a combination of a chemotherapy drug (Taxol), and a monoclonal antibody (Ramucirumab), a drug that prevents blood vessel formation and can prevent cancer growth. Depending on patient health, those who cannot tolerate both drugs together may be prescribed a single-drug treatment plan to prevent additional side effects.

Treatment for Locally Advanced Gastric and Esophageal Cancers

Locally advanced gastric and esophageal cancers were traditionally treated with surgery alone, however, it is now known that the addition of chemotherapy before and after surgery can improve patient survival by about 15 percent. The most commonly used drug treatment is FLOT, a combination of 5-FU, oxaliplatin, and docetaxel. FLOT chemotherapy treatment before surgery works by downstaging the tumor and allowing for a more successful resection, and additional chemotherapy after surgery can treat any remaining cancer cells. .

Immunotherapy Treatment Options Gastric and Esophogeal Cancers

Immunotherapy is now an FDA approved treatment in the third line setting after receiving chemotherapy. The possibility of immunotherapy treatment being effective against gastric and esophageal cancers is determined by the status of specific biomarkers, and can improve long term survival in a subset of patients.

Pembrolizumab

Pembrolizumab is a newer immunotherapy drug used for the treatment of different cancers, most notably lung cancer, colon cancer, skin cancer, and cancer of the endocrine glands. By blocking a specific immune receptor, Pembrolizumab causes an increased activity of the immune system, allowing the body to better destroy cancer cells. Due to an increase in immune function, symptoms similar to an autoimmune disease may arise.

Ramucirumab

Ramucirumab, a well-tolerated anti-angiogenesis drug with few side effects, and is often used during second-line treatment of gastric and esophageal cancers. Anti-angiogenesis drugs, like Ramucirumab, are prescribed to halt tumor growth and improve overall patient progress through prevention of new blood vessel formation.

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