Cause for hope in relation to esophageal cancer

For patients with recur­rent esophageal or upper gas­tric can­cer, the New Eng­land Jour­nal of Med­i­cine reports the suc­cess­ful use of adju­vant immunother­a­py as a new and promis­ing treat­ment option. The results are from the phase III Check­Mate 577 tri­al, and the new ther­a­py has now received Euro­pean approval.

Researchers at the Uni­ver­si­ty Med­ical Cen­ter Mainz, in col­lab­o­ra­tion with inter­na­tion­al coop­er­a­tion part­ners, have suc­ceed­ed in dis­cov­er­ing a new and promis­ing treat­ment option for patients with recur­rent esophageal or upper gas­tric can­cer. If the cur­rent stan­dard treat­ment, con­sist­ing of chemother­a­py, radi­a­tion ther­a­py and surgery, is sup­ple­ment­ed by post­op­er­a­tive drug immunother­a­py, the risk of recur­rence is reduced and patients have a high­er chance of liv­ing longer with­out recur­rence of can­cer. The results of the phase III Check­Mate 577 tri­al have been pub­lished in the renowned jour­nal “New Eng­land Jour­nal of Med­i­cine” and have now led to Euro­pean approval.

It is not uncom­mon for patients with can­cer of the esoph­a­gus and upper stom­ach to devel­op a recur­rence of the can­cer short­ly after inten­sive treat­ment of the tumor that first appeared. Until now, the stan­dard treat­ment of patients with local­ly advanced esophageal or upper gas­tric can­cer con­sist­ed of a com­bi­na­tion of so-called neoad­ju­vant, i.e. prepara­to­ry, chemother­a­py and radi­a­tion ther­a­py fol­lowed by sur­gi­cal removal of the tumor. How­ev­er, this com­bi­na­tion of ther­a­pies has not suc­ceed­ed in reduc­ing the risk of recur­rence for a pro­longed peri­od of time.

With the aim of reduc­ing the like­li­hood of recur­rence and thus offer­ing affect­ed patients the chance of longer sur­vival, sci­en­tists from the I. Med­ical Clin­ic and Poly­clin­ic of the Uni­ver­si­ty Med­ical Cen­ter Mainz par­tic­i­pat­ed in the inter­na­tion­al, ran­dom­ized, dou­ble-blind, place­bo-con­trolled Phase III study “Adju­vant Nivolum­ab in Resect­ed Esophageal or Gas­troe­sophageal Junc­tion Can­cer”, or Check­mate 577.

In this study, Prof. Dr. Markus Möh­ler, head of the gas­troen­tero­log­i­cal-onco­log­i­cal out­pa­tient clin­ic of the I. Med­ical Clin­ic and Poly­clin­ic of the Uni­ver­si­ty Med­ical Cen­ter Mainz, and col­leagues eval­u­at­ed a post­op­er­a­tive, so-called adju­vant ther­a­py in patients in whom no patho­log­i­cal­ly com­plete remis­sion was achieved and the dis­ease was still diag­nos­ti­cal­ly detectable. For this pur­pose, they chose an immuno-onco­log­i­cal approach: a drug that specif­i­cal­ly sup­ports the immune sys­tem after tumor resec­tion and acti­vates it to fight off can­cer cells that are still present but not vis­i­ble, there­by pre­vent­ing metas­tases from form­ing. The active ingre­di­ent is an immune check­point inhibitor, the anti-PD‑1 mon­o­clon­al anti­body nivolumab.

This adju­vant immunother­a­py, described in detail in the New Eng­land Jour­nal of Med­i­cine, had a pos­i­tive effect in the study par­tic­i­pants: they lived an aver­age of 22 months longer and thus twice as long with­out a recur­rence of tumor dis­ease as those sub­jects who received only a place­bo. The sci­en­tists at Mainz Uni­ver­si­ty Med­ical Cen­ter and the coop­er­at­ing research teams have thus suc­ceed­ed for the first time in achiev­ing a long-term dis­ease-free sur­vival advan­tage in patients with advanced esophageal can­cer treat­ed with var­i­ous therapies.

Fol­low­ing the U.S., Ger­many and the Euro­pean Com­mis­sion have now also approved nivolum­ab for this adju­vant treat­ment. There is there­fore rea­son for hope for the approx­i­mate­ly 5,550 men and 1,750 women in Ger­many who devel­op this rare malig­nant dis­ease each year. Esophageal can­cer is the sev­enth most com­mon can­cer world­wide and the cause of more than half a mil­lion deaths each year.