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A drug that boosts the immune system offers a rare glimmer of hope for people with cancer that resists most treatments.
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VonGina Kolata
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For decades, esophageal cancer has defied scientific attempts to find a therapy that would prolong patient survival and claim the lives of famous people like Humphrey Bogart, Christopher Hitchens and Ann Richards, former governor of Texas, year after year.
now alarge clinical studygives hope that a drug that activates the immune system to attack cancer cells could double disease-free survival for patients from 11 months to 22 months. The study was published on Wednesday in the New England Journal of Medicine.
"It's a game changer," said Dr. David Ilson, an esophageal cancer specialist at Memorial Sloan Kettering Cancer Center in New York, who wrotean editorialmonitoring of investigations. "We've waited a long time for this."
In the Bristol-Myers Squibb-sponsored study, 794 patients in 29 countries were randomly assigned to receive infusions of the drug, nivolumab, or placebo.
All patients hadchemotherapyand radiation, followed by surgery to remove the cancer. As is often the case, the pathology reports showed that the surgery did not kill all the cancer cells that still lurked in the lymph nodes and elsewhere, setting the stage for these patients to have their cancers come back as incurable metastases.
Nivolumab is approved for some patients with other cancers, such as Hodgkin's lymphoma, melanoma, and colorectal cancer. With the new study, experts hope the drug will be easily approved for the treatment of early-stage esophageal cancer.
Dr Ronan Kelly, director of the Charles A. Sammons Cancer Center at Baylor University Medical Center and lead author of the new study, said he and the other researchers urgently want to help the 75% of patients who undergo exceptionally difficult radiation sequences. , chemotherapy and surgeries that disfigure the digestive system, only to discover that the cancer is still there or has a high chance of coming back.
New developments in cancer research
Map 1 of 5
advances in the field.In recent years, advances in research have changed the way cancer is treated. Here are some recent updates:
ovarian cancer.Based on evidence that ovarian cancer usually originates in the fallopian tubes rather than the ovaries, the Ovarian Cancer Research Alliance urges even women who are not genetically at risk for ovarian cancer, i. H. Most women:Having your fallopian tubes surgically removedwhen they finished giving birth to their children and are still planning a gynecological operation.
breast cancer.A new study suggestsSurgery may not always be necessary for all breast cancer patients.. A small, early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether.
cancer vaccines.For too long, the promise of cancer vaccines that would protect healthy people at high risk of cancer remained just with researchers. Now, however, encouraging data in animals and preliminary studies in human patientssome doctors are optimistic.
colon cancerA small study in which 18 colorectal cancer patients took the same drug, dostarlimab, appears to have produced a surprising result:The cancer disappeared in each of the participants.Experts believe that this study is the first in history to achieve such results.
With no other form of treatment, "we knew that many would come back quickly," said Dr. Kelly. The additional chemotherapy was not only difficult for the patients to tolerate, it also didn't seem to help. Nivolumab has few side effects and is worth a try.
Esophageal cancer is rare in the United States, accounting for 1% of all cancers; about 15,000 patients die each year. But it's the seventh most common cancer worldwide and is commonly seen in East Asia, although it's not clear why, Dr. Ilson.
Smoking is a risk factor, but researchers don't believe that high smoking rates in China, for example, explain the high incidence. "We don't think it's eco-friendly," said Dr. Ilson.
Other risk factors include alcohol consumption and heartburn.
Because cancer is so rare in the United States, research hasn't paid much attention to it. While new treatments have revolutionized the outlook for other cancer patients, those with esophageal cancer could only watch wistfully.
This has hit people with the disease hard, said Mindy Mordecai. Her husband John died of esophageal cancer in March 2008. She founded an advocacy group called the Esophageal Cancer Action Network.
"You have no idea how demoralizing it is to see all the progress going on around you. 'Please sir, may I have some more porridge?'" he said, quoting Oliver Twist, Charles Dickens' character in the novel of the same name, and asking for a pittance.
The new findings must be seen in the context of what patients go through when they develop esophageal cancer, experts said. Most discover they have cancer after it has progressed so far that they are unlikely to survive.
But every patient hopes to be among the lucky ones. "Our patients are always waiting for the other shoe to drop," Mordecai said. "You have to understand what it's like to live with that every day."
The first step for most is chemotherapy and radiation therapy. The treatment is so harsh that an oncology nurse told Mordecai that it "brings Navy Seals to their knees," Mordecai recalled.
Chemotherapy has serious side effects, and radiation causes a burning sensation that makes swallowing difficult. "The food isn't falling," said Mordechai. "You just feel bad."
The next step is major surgery. A doctor removes most of the patient's esophagus, the tube that runs from the mouth to the stomach, and then grabs the stomach, pulls it up, and attaches it to a remaining esophageal stump.
The result is a vertical rather than horizontal stomach that lacks the sphincter muscle that normally prevents stomach acid from escaping. For the rest of their lives, patients are never allowed to lie down; When they do, stomach contents, including acid, are dumped down their throats. You may choke, cough and aspirate.
Recovery is difficult and morbidity and mortality are high. But most patients go ahead with surgery after considering their options. Refusing treatment means giving up and allowing the cancer to close down the esophagus to the point where some cannot even swallow their own saliva, said Dr. Paul Helft, professor of surgery and ethicist at the University of California School of Medicine at Indiana University.
The treatment is so long and devastating that Dr. Often used to teach medical students and other trainees about informed consent, they help how patients must be fully informed before starting any specific treatment. In particular, patients with esophageal cancer should be informed that they are likely to experience a recurrence within the first year.
Mrs. Mordecai said her husband had surgery in late September 2007. On December 6th he had persistent liver metastases. Now, he said, patients may have a glimmer of hope.
Dr Ilson, who has spent his career developing therapies to help patients with esophageal cancer, said he didn't expect this treatment to be successful: "We all become nihilistic when faced with years of negative studies."
"This really is a historic document," he added, and the drug "is becoming a new standard of care."
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FAQs
What is the new treatment for esophageal cancer? ›
Trastuzumab, a medication that targets a gene called HER2, has been approved by the U.S. Food and Drug Administration (FDA) as a first-line treatment of esophageal cancer that has an abnormal alteration in the HER2 gene (“HER2-positive” esophageal cancer).
What is the success rate of KEYTRUDA for esophageal cancer? ›Cancer did not progress in 20% (76 out of 373) of patients receiving KEYTRUDA with chemotherapy compared to 11% (43 out of 376) of patients receiving chemotherapy alone.
Can KEYTRUDA cure esophageal cancer? ›KEYTRUDA is a prescription medicine used to treat a kind of cancer called esophageal or certain gastroesophageal junction (GEJ) carcinomas that cannot be cured by surgery or a combination of chemotherapy and radiation therapy.
Does esophageal cancer ever go into remission? ›Currently available combination chemotherapy treatment for stage IV cancer results in complete remission in up to 20% of patients, with average survival of 8-12 months.
What kills esophageal cancer? ›Chemotherapy. Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy.
How much longer does KEYTRUDA prolong life? ›In this trial, Keytruda + Alimta and carboplatin demonstrated an objective response rate of 55% which is nearly nearly double the 29% achieved with chemotherapy alone. The Keytruda regimen also delayed the time to cancer progression from 8.9 months to 13 months extending the overall cancer free survival.
What are the chances of beating esophageal cancer? ›The overall five-year survival rate for esophageal cancer is about 20%, but survival rates can range from 5% to 47%. When esophageal cancer is found early and when it is small, the five-year survival rate is higher.
How long do most people stay on KEYTRUDA? ›Some patients can stay on KEYTRUDA for up to a year or two. Your doctor will decide how long you will be on treatment. Always talk to your doctor about what to expect while taking KEYTRUDA.
Who are some famous esophageal cancer survivors? ›For decades, esophageal cancer has defied scientific attempts to discover a therapy that extends patients' survival, year after year claiming the lives of such illustrious people as Humphrey Bogart, Christopher Hitchens and Ann Richards, the former governor of Texas.
What is the 10 year survival rate for esophageal cancer? ›Overall, more than 1 in 10 people diagnosed with oesophageal cancer today are predicted to survive their disease for at least ten years.
Where is the best place to treat esophageal cancer? ›
Mayo Clinic doctors have experience treating this disease. Each year, Mayo Clinic doctors care for more than 1,100 people with esophageal cancer. The latest techniques and technologies. Mayo Clinic is dedicated to developing cutting-edge diagnostic tests and innovative treatments for patients with esophageal cancer.
Can you live 10 years with esophageal cancer? ›Survival for all stages of oesophageal cancer
more than 15 out of every 100 (more than 15%) will survive their cancer for 5 years or more. more than 10 out of 100 (more than 10%) will survive their cancer for 10 years or more.
While everyone is fortunate to survive cancer, few survive esophageal cancer; it is a very rare cancer and one even more rare to survive.
Can you fully recover from esophageal cancer? ›Most patients with esophageal cancer have advanced to the middle or late stage when they seek medical treatment. The 5-year survival rate after treatment for early esophageal cancer is 90%, while the 5-year survival rate of patients for middle or late stage is only 6% ~ 15%.
What vitamins prevent esophageal cancer? ›Share on Pinterest Zinc was found to halt the growth of esophageal cancer cells by blocking overactive calcium signaling. Zinc is a mineral present in a variety of foods – including oysters, red meat, poultry, beans, nuts, and whole grains – and it is also available as a dietary supplement.
What is the life expectancy of a person with esophagus cancer? ›The 5-year survival rate of people with cancer located only in the esophagus is 46%. The 5-year survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 26%. If it has spread to distant parts of the body, the survival rate is 5%.
How long do most people live with esophageal cancer? ›Although many people with esophageal cancer will go on to die from this disease, treatment has improved and survival rates are getting better. During the 1960s and 1970s, only about 5% of patients survived at least 5 years after being diagnosed. Now, about 20% of patients survive at least 5 years after diagnosis.
What is the best hospital for esophageal surgery? ›Expertise and rankings
Mayo Clinic is a high-volume center for esophagectomy. Each year, Mayo Clinic surgeons perform around 130 esophagectomies, ranking among the top in the country.
- Capecitabine.
- Ipilimumab.
- Keytruda (Pembrolizumab)
- Nivolumab.
- Opdivo (Nivolumab)
- Pembrolizumab.
- Xeloda (Capecitabine)
- Yervoy (Ipilimumab)
According to data presented at the ESMO 2022 conference, Keytruda pared down the risk of event-free survival by 33% in patients with PD-L1 expression between 1% and 49% and by 22% in those with PD-L1-negative tumors.
What is the death rate of KEYTRUDA? ›
He noted that in the case of metastatic lung cancer, where the disease has advanced to other areas of the body, Keytruda in combination with chemo has improved the five-year survival rate to 40%. Typically, the survival rate is only 5%.
What happens after 2 years on KEYTRUDA? ›Of the patients who completed two years of treatment with KEYTRUDA (n=39/154), 81.4% were alive at five years and nearly half (46%) remained treatment-free. These data suggest that patients who completed two years of treatment with KEYTRUDA experienced a long-term OS benefit.
Can you live a long life after esophageal cancer? ›Esophageal cancer is the eighth most common cancer worldwide, with approximately 600,000 new cases every year,1,2 and has a poor prognosis with overall 5-year survival below 20%.
Why is esophageal cancer on the rise? ›The exact reason for the uptick of esophageal cancer in younger folks is not fully known, but soaring rates of obesity, unhealthy diets, and chronic heartburn or gastroesophageal reflux disease (GERD) are likely factors, and they all tend to travel together, said study author Dr. Bashar Qumseya.
Can you beat stage 3 esophageal cancer? ›In general, concurrent radiation and chemotherapy results in 3-5 year survival rates of 20-30%, with average survival rates of less than one year. The combination of radiation and chemotherapy is superior to treatment with radiation therapy alone.
What cancers does KEYTRUDA cure? ›Keytruda is used alone or with other drugs to treat certain types of breast cancer, skin cancer (squamous cell carcinoma of the skin, Merkel cell carcinoma, and melanoma), colorectal cancer, endometrial cancer, renal cell carcinoma (a type of kidney cancer), esophageal cancer, gastroesophageal junction cancer, stomach ...
What is the alternative to KEYTRUDA? ›Opdivo (nivolumab) and Keytruda (pembrolizumab) are two immunotherapy drugs used to treat a number of different types of cancer. They are monoclonal antibodies that have similar efficacy and safety profiles and are both programmed death receptor-1 (PD1) inhibitors, which were first approved in the US in 2014.
Can you go into remission with KEYTRUDA? ›Response and effectiveness. Many people achieve remission with Keytruda; however, some may not.
What actor has esophageal cancer? ›Eddie Money. This rock star of “Two Tickets to Paradise” fame learned he had esophageal cancer after a routine checkup. The disease was already at stage IV, the most advanced, and had spread to his lymph nodes and liver.
What country has the highest rate of esophageal cancer? ›| Rank | Country | Number |
|---|---|---|
| World | 604,100 | |
| 1 | Malawi | 1,756 |
| 2 | Mongolia | 398 |
| 3 | Bangladesh | 21,745 |
How long does it take for esophageal cancer to metastasize? ›
Distant metastases mostly develop within 6 months of radical treatment, and median survival after diagnosis of distant metastasis is only 5 months (4–6). Therefore, distant metastasis remains the major cause of treatment failure and death in esophageal cancer.
Where does esophageal cancer spread to first? ›The most common place for oesophageal cancer to spread to is the liver. It can also spread to the lungs or lymph nodes.
Can you survive esophageal cancer without surgery? ›If the cancer is in the upper part of the esophagus (in the neck), chemoradiation may be recommended as the main treatment instead of surgery. For some patients, this may cure the cancer. Close follow-up with endoscopy is very important in looking for possible signs of cancer returning.
Can esophageal cancer be slow growing? ›Stomach and oesophageal cancers present as malignant tumours found in the tissues of the stomach or oesophagus. It is a slow growing cancer that may grow for many years before symptoms are felt.
What is the average age of onset of esophageal cancer? ›The average age at diagnosis is 68.
While esophageal cancer can be diagnosed at any age, it is most common among people aged 65-74. People under the age of 55 account for less than 15% of cases.
It may cause you to feel light-headed or sick to your stomach, or to have cramps and diarrhea. Most people go back to work or their normal routine after 6 to 12 weeks. You will need more time to get better if you need other treatment for cancer, such as chemotherapy.
What is the average life expectancy for esophageal cancer? ›Although many people with esophageal cancer will go on to die from this disease, treatment has improved and survival rates are getting better. During the 1960s and 1970s, only about 5% of patients survived at least 5 years after being diagnosed. Now, about 20% of patients survive at least 5 years after diagnosis.
How long can you live after esophagectomy? ›Minimally invasive Ivor Lewis esophagectomy offers favorable long-term outcomes. Overall survival was 62% at 3 years and 56% at 5 years at our safety-net hospital. Age, Karnofsky score, stage IV, and disease recurrence affect overall survival.