Systemic therapy for advanced gastroesophageal cancers: progress and pitfalls

Area of Science:

• Medical Oncology
• Gastroenterology
• Cancer Research

Background:

• Advanced gastroesophageal cancer is aggressive with a poor prognosis when surgical resection is not an option.
• Current treatment focuses on systemic therapies, including cytotoxic and biological agents.

Purpose of the Study:

• To review key clinical trials defining the standard of care for advanced gastroesophageal cancer.
• To highlight progress and challenges in systemic, targeted, and immunotherapies.
• To provide a framework for applying new treatments effectively.

Main Methods:

• Review of pivotal clinical trials and ongoing studies in advanced gastroesophageal cancer.
• Analysis of systemic cytotoxic and biological therapies.
• Survey of anti-HER2 agent trials and biomarker studies.
• Evaluation of trials involving immune checkpoint inhibitors.

Main Results:

• Significant advancements have been made with systemic cytotoxic and biological therapies.
• Targeted therapy with anti-HER2 agents faces challenges due to molecular intratumoral heterogeneity.
• Immune checkpoint inhibitors show promise in metastatic and locally advanced gastroesophageal cancer.

Conclusions:

• Optimizing current treatments requires understanding therapeutic pitfalls.
• Intratumoral heterogeneity complicates anti-HER2 targeted therapy.
• Immune checkpoint inhibitors represent a significant new therapeutic avenue for advanced gastroesophageal cancer.