Esophageal Cancer: Treatment paradigms need revolution not evolution

Globally, esophageal cancer is the ninth most common tumor type and seventh leading cause of cancer-related death, however, its incidence fluctuates widely depending on geographical area. While relatively uncommon in Western countries, 50% of patients still present with locally advanced unresectable or distant metastatic disease, where treatment is complicated and chances of a cure are reduced.

As the incidence of esophageal cancer subtypes shift due to a changing prevalence of risk factors including an increasing incidence of obesity and gastroesophageal reflux disease, preventative strategies may take on a more prominent role and existing treatment paradigms will need to evolve in order to yield improved patient outcomes.

Given that the majority of esophageal cancer patients present with locally advanced unresectable or distant metastatic disease, as reflected by poor overall survival rates and disease prognosis, increased rates of earlier diagnosis and greater research into more effective systemic therapies is crucial.

Due to a relatively low incidence in the West, esophageal cancer has not been the most commercially attractive indication for US and EU drug developers, as evidenced by the lack of approved agents for its treatment. However, there are numerous targeted therapies in Phase II trials, which show potential to transform existing treatment paradigms.

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