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Exploring Immunotherapy in Patients With Esophageal Cancer

Manish A. Shah, MD
Published Online:5:13 PM, Tue July 3, 2018

Manish A. Shah, MD, director of Gastrointestinal Oncology at Weill Cornell Medicine, discusses the need for targeted therapies beyond the second-line setting in esophageal cancer. While this is a deadly disease with most metastatic patients dying within a year, a recent clinical trial with pembrolizumab (Keytruda) addresses an unmet need in the population, Shah says.

There are a few targeted therapies, including active cytotoxic drugs, that have modest activity in this patient population, but more research is necessary. Pembrolizumab, a PD-1 inhibitor, was examined in patients with esophageal cancer, both squamous cell carcinoma and adenocarcinoma, who are either PD-L1-positive or -negative.

Overall, there was a 10% response rate, including a 16% response in the PD-L1-positive population and a 6% response in the PD-L1-negative population. There also seemed to be more responses in the squamous cell carcinoma group, but Shah says all of the responses were modest. Patients benefited from the immunotherapy, living an additional 8 months or longer.

Shah says these results are lifechanging and contribute to the literature on the use of immunotherapies in gastrointestinal cancers. Unless your patient is MSI-high or mismatch repair deficient, there is modest activity for most tumor types.
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