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Review
. 2023 Feb;8(1):100789.
doi: 10.1016/j.esmoop.2023.100789. Epub 2023 Feb 13.

How we treat esophageal squamous cell carcinoma

H C Puhr  1 , G W Prager  1 , A Ilhan-Mutlu  2
Affiliations
Review

How we treat esophageal squamous cell carcinoma

H C Puhr et al. ESMO Open. 2023 Feb.

Abstract

Esophageal squamous cell carcinoma (ESCC) poses a major challenge for clinicians as the prognosis is poor and treatment options are limited. However, recent advances in immunotherapy have significantly changed the treatment algorithm of ESCC. Patients with early ESCC should undergo an endoscopic resection. If histological margins are infiltrated with tumor cells or other risk factors for lymph node metastasis are present, further resective surgery should be offered. In a locally advanced setting, radiochemotherapy with or without resection remains the standard of care. In the absence of pathological complete response after neoadjuvant radiochemotherapy and R0 resection, adjuvant immunotherapy for 1 year should be administered to improve disease-free survival. In metastatic first-line setting, combination of platin/fluoropyrimidine-based systemic chemotherapy with checkpoint inhibitors is the novel standard of care for all-comers in the United States and for patients with programmed death-ligand 1 positivity in Europe. Immunotherapy has also been approved in a second-line setting. However, the benefit from immunotherapy reinduction is still unknown and, therefore, standard second-line chemotherapy with taxanes or irinotecan is still the treatment of choice after progression on immunochemotherapy. It is of highest importance that treatment decisions are based on informed patient wishes and are discussed in an interdisciplinary tumor board. This review summarizes how to manage, in our opinion, patients with ESCC and gives a practical overview of the treatment strategies in Europe.

Keywords: cancer; esophageal; squamous cell carcinoma; treatment.

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Figures

Figure 1
Figure 1
Algorithm for the treatment of locally advanced (A) and advanced (B) esophageal SCC. ATT, ATTRACTION; CM, CheckMate; CPS, combined positive score; ESCAT, ESMO Scale for Clinical Actionability of molecular Targets; FP, fluoropyrimidine; KN, KEYNOTE; SCC, squamous cell carcinoma; TPS, tumor proportion score. a40-55 Gy in resectable setting, up to 65 Gy in definitive setting. Chemotherapy with platin/taxane and platin/fluoropyrimidine available. bNot approved by European Medicines Agency but by United States Food and Drug Administration.
See this image and copyright information in PMC

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