Does Immunotherapy Treat Esophageal Cancer?

What are the benefits of immunotherapy for esophageal cancer?

Immunotherapy is a rapidly evolving treatment for esophageal cancer.

Doctors use immunotherapy:

• either by itself or combined with chemotherapy to treat people with advanced cancer that can’t be treated surgically
• to treat people who relapse after a previous treatment hadn’t worked
• to treat people with cancer that comes back after previous remission

Large clinical trials have found that combining immunotherapy and chemotherapy offers benefits for some people compared with receiving chemotherapy alone. They include:

• higher effectiveness
• relatively low toxicity
• improved survival
• better quality of life

Side effects of immunotherapy for esophageal cancer

According to the American Cancer Society, common side effects of immune checkpoint inhibitors are skin rash and itchiness.

Other possible side effects that occur less commonly include:

• fatigue
• fever
• poor appetite
• cough
• nausea
• constipation
• muscle pain or joint pain
• diarrhea

Rarer but more serious side effects can include infusion reactions and autoimmune reactions.

An infusion reaction occurs in fewer than 5% of people. It’s an overreaction of your immune system to immunotherapy drugs. Common symptoms include:

• fever
• chills
• facial flushing
• itchy skin
• dizziness
• trouble breathing
• wheezing

An autoimmune reaction is when your body’s immune system overreacts and attacks healthy tissue in your body. It can cause serious to life-threatening complications involving your:

• lungs
• intestines
• kidneys
• skin
• glands

Complications, such as an autoimmune reaction, are all treated with steroids.

What is the success rate of immunotherapy for esophageal cancer?

There’s strong evidence that immunotherapy may improve survival for some people with esophageal cancer. But the current response rate is lower than 30%, and most people develop resistance.

In a large phase 3 clinical trial called the “CheckMate 648” trial, researchers found that people treated with the immune checkpoint inhibitor nivolumab combined with either chemotherapy or another checkpoint inhibitor called ipilimumab had increased survival compared with people who received chemotherapy alone.

They reported the following median survival rates. A median survival rate is the amount of time half of people live.

Immunotherapy procedure for esophageal cancer

You can prepare your body for immunotherapy by:

• eating a balanced overall diet
• avoiding or minimizing alcohol
• quitting smoking, if you smoke (this can be difficult, but a doctor can help build a cessation plan that works for you)
• exercising regularly, within your ability

You’ll receive your immunotherapy treatment in your doctor’s office, hospital, or cancer treatment center. The drugs are usually administered through an intravenous (IV) line in your arm. Each treatment can take up to roughly 90 minutes, and you may receive treatment every 2, 3, or 4 weeks depending on the type of medication.

After starting immunotherapy, you may develop some side effects. It’s important to alert your doctor of any changes you notice in your body. Many side effects are easier to resolve the earlier treatment is started.

Who should consider immunotherapy for esophageal cancer?

Immunotherapy may be beneficial for people with advanced esophageal cancer or people with cancer that has returned.

Some studies suggest that some subtypes of esophageal cancer may respond better to immunotherapy than others, but research is still inconclusive.

The FDA has approved nivolumab for everybody with advanced esophageal cancer based on the results of the CheckMate 649 trial. People with a higher expression of a protein called PD-L1 seem to have the best response.

Who should avoid it?

There are no specific conditions that make you ineligible for the drugs nivolumab or pembrolizumab, but there hasn’t been enough research to evaluate their safety for people who are pregnant or breastfeeding.

It’s been reported that people with autoimmune or inflammatory conditions have higher rates of hospitalization or need for immunosuppressants after taking the drug nivolumab than people without these conditions.

Immunotherapy can cost more than $100,000 per year. The cost of treatment may influence your decision about whether it’s right for you.

Alternative treatments for esophageal cancer

Other standard treatments for esophageal cancer include:

• surgery
• radiation therapy
• chemotherapy
• chemotherapy and radiation therapy together
• laser therapy, to minimize symptoms
• electrocoagulation, to reduce symptoms

Combing a type of medication that specifically attacks cancer cells called targeted therapy to other treatments is being investigated in clinical trials, usually in people with advanced esophageal cancer where the tumor exhibits presence of a mutation.

Frequently asked questions about immunotherapy for esophageal cancer

Here are some frequently asked questions people have about immunotherapy for treating esophageal cancer.

Can immunotherapy cure esophagus cancer?

Advanced esophageal cancer is very difficult to treat, and the survival rate remains low even with immunotherapy. Treatment usually focuses on prolonging survival and reducing your symptoms, rather than a cure.

How long does immunotherapy work for esophageal cancer?

Most people who receive immunotherapy to treat esophageal cancer develop drug resistance. In the CheckMate 648 study, half of people who received nivolumab and ipilimumab had a response that lasted less than 4.2 months.

What’s the best treatment for esophageal cancer?

The best treatment option for your cancer is highly dependent on how advanced your cancer is. Radiation therapy, surgery, and chemotherapy are often used to treat early stage esophageal cancer. Immunotherapy and targeted therapy may help treat late stage esophageal cancer.

Chemotherapy may also be able to temporarily control the growth of advanced-stage cancer and delay the progression of symptoms.

Takeaway

Immunotherapy is a promising new treatment to treat advanced esophageal cancer or cancer that returns after another treatment. Researchers are still investigating how to best use it. Currently, fewer than half of people respond to immunotherapy.

Immunotherapy may help prolong survival but is unlikely to cure advanced esophageal cancer. Your doctor can help you decide if it may be a beneficial part of your cancer treatment.