Strategies to Improve Treatment - Stage III Esophageal Cancer

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

Researchers are currently investigating new treatments for stage III esophageal cancer. Participation in trials of these treatments can lead to improved therapies. If you wish to participate in a clinical trial, please talk to your doctor about the potential benefits and side effects of the treatment.

• Supportive care - Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but they also may prevent the optimal delivery of therapy at its planned dose and schedule. To achieve optimal outcomes from treatment and improve quality of life, it is important to manage appropriately the side effects resulting from cancer and its treatment.
• New adjuvant regimens (treatment after surgery) - Studies show that treating patients with radiation therapy and chemotherapy together improve survival time when compared with radiation therapy alone for patients with stage III esophageal cancer. Developing new multidrug chemotherapy treatment regimens that incorporate new or additional anticancer therapies alone or in combination with radiation therapy for use as treatment is an ongoing area of clinical research. Researchers are evaluating the taxanes, Gemzar^® (gemcitabine), Camptosar^® (irinotecan), and other newer chemotherapy drugs in patients with stage III cancer. These are among the most active drugs developed for the treatment of esophageal cancer.
• New neoadjuvant regimens (treatment before surgery) - Developing new multidrug chemotherapy treatment regimens that incorporate new or additional anticancer therapies is an ongoing area of clinical research. Neoadjuvant therapy may consist of chemotherapy alone or in combination with radiation therapy or biologic agents (substances that come from living organisms).  An analysis of individual patient data from nine preoperative chemotherapy trials (with a total of 2,102 patients) involving esophageal squamous cell carcinoma and adenocarcinoma has shown an overall improvement in survival time and should now be considered the new treatment paradigm. The potential effectiveness of neoadjuvant chemotherapy and radiation therapy is still being studied in clinical trials, which are primarily evaluating newer combination chemotherapy regimens.
• Neoadjuvant plus adjuvant treatment - Although initial clinical trials have not shown this approach to be superior to surgery alone, researchers continue to evaluate neoadjuvant chemotherapy before surgery followed by additional adjuvant chemotherapy after surgery.
• Gene therapy - Gene therapy involves transferring new genetic material into a cell for therapeutic benefit. Researchers perform this transfer by replacing or inactivating a faulty (dysfunctional) gene or replacing or adding a working (functional) gene into a cell to restore normal function. Gene therapy attempts to control the rapid growth of cancer cells, control cancer cell death, and help the immune system to kill cancer cells.

Currently, there are no approved gene therapies for treating esophageal cancer. A few gene therapy studies are ongoing in patients with esophageal cancer resistant to treatment. Patients with earlier stages of esophageal cancer may receive these therapies, if the studies are successful.