OnCo
cancersCancer

Oesophageal cancer

Oesophageal cancer is really two diseases sharing one organ: squamous cell carcinoma, which dominates in Asia, and adenocarcinoma, which dominates in the West and is treated like gastric cancer. Immunotherapy is now standard, and the bispecific ADC iza-bren posted a positive phase 3 in the squamous type in 2026.

Oesophageal cancer causes about 510,000 new cases and 445,000 deaths a year, making it the seventh most common cancer and sixth leading cause of cancer death. It is two diseases: squamous cell carcinoma (ESCC, ~85% globally, driven by tobacco, alcohol, hot beverages, and nutritional factors along a belt from Iran through Central Asia to China) and adenocarcinoma (EAC, dominant in the West, arising from Barrett's oesophagus through reflux and obesity). Most patients present with dysphagia and locally advanced or metastatic disease; five-year survival is about 20%. Japan and parts of China screen high-risk populations endoscopically and cure early squamous cancers with endoscopic resection.

Localised disease is treated with multimodality therapy. CROSS chemoradiation followed by oesophagectomy gives 10-year survival of 38% versus 25% for surgery alone; perioperative FLOT is the alternative for adenocarcinoma (ESOPEC favoured it). Definitive chemoradiation is used for cervical tumours and unfit patients. CheckMate 577 added a year of adjuvant nivolumab for residual disease after chemoradiation (DFS 22.4 vs 11.0 months), and SANO showed that patients with a clinical complete response can be watched rather than operated on with non-inferior survival. Advanced disease is treated with chemotherapy plus PD-1 blockade: pembrolizumab (KEYNOTE-590, both histologies), nivolumab ± ipilimumab (CheckMate 648, squamous), tislelizumab (RATIONALE-306, squamous PD-L1 ≥1%), and camrelizumab or sintilimab in China. HER2-positive adenocarcinoma follows the gastric pathway (trastuzumab, zanidatamab after HERIZON-GEA-01, T-DXd second line). In 2026 the EGFR×HER3 bispecific ADC izalontamab brengitecan became the first agent to improve overall survival in second-line ESCC after immunotherapy (PANKU-Esophagus01).

Open fronts: whether PD-1 blockade added to definitive chemoradiation raises cure rates (KEYNOTE-975, SKYSCRAPER-07 and Chinese trials), how far organ preservation can be pushed, non-endoscopic screening for Barrett's (BEST4), the absence of targets in squamous disease beyond PD-1 and now EGFR/HER3, and the persistent gap between Asian and Western outcomes that early detection explains.

State of the art today

  • Immunotherapy in first line and adjuvant.
  • First bispecific ADC phase 3 success in ESCC.
  • Chemo-immunotherapy is first-line standard in both histologies, replicated in five phase 3 trials; PD-L1 defines the size of benefit.
  • A chemotherapy-free immunotherapy doublet (nivolumab + ipilimumab) is an option in squamous disease.
  • The first bispecific ADC with an OS benefit in second-line ESCC (iza-bren, 2026) gives post-immunotherapy squamous cancer its first targeted option.
  • Endoscopic screening and resection in East Asia cure most early squamous cancers; Barrett's surveillance and ablation prevent adenocarcinoma in the West.
Show survival figures (2)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • Chemoradiation before surgery (CROSS) has a durable 13-point 10-year survival gain; organ preservation after complete response is non-inferior (SANO).
  • Adjuvant nivolumab doubles disease-free survival after incomplete response to chemoradiation (CheckMate 577), though OS was not significantly improved.
Who it affects
Show survival figures (1)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • ~510,000 cases and ~445,000 deaths per year; ~85% squamous cell carcinoma globally, adenocarcinoma dominant in North America, Western Europe, and Australia; 5-year survival ~20% overall, >80% for endoscopically treated early disease.

Where the cases are

Cases by country · GLOBOCAN 2022
All countries →

Site: Oesophagus. World: 511,054 new cases, 445,391 deaths.

#CountryNew casesDeaths
1China224,012187,467
2India70,63766,410
3Bangladesh25,23224,363
4Japan19,92612,161
5United States of America18,74716,469
6Brazil10,98510,393
7United Kingdom9,6018,595
8Russian Federation9,3458,359
9Pakistan9,2898,704
10Germany7,3106,399

Standard of care

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Localised

Neoadjuvant chemoradiation (CROSS) or perioperative FLOT → surgery → nivolumab if residual disease.

NCCN Guidelines: Esophageal and Esophagogastric Junction Cancers
NivolumabIMRT / IGRT (modern external beam)
Advanced

Chemotherapy + pembrolizumab/nivolumab; iza-bren in trials.

NCCN Guidelines: Esophageal and Esophagogastric Junction Cancers
PembrolizumabIzalontamab brengitecan
Prevention and screening

Tobacco and alcohol control; endoscopic screening of high-risk populations in China and Japan (Lugol chromoendoscopy); surveillance of Barrett's oesophagus with ablation or resection of dysplasia; non-endoscopic capsule-sponge screening in trials (BEST4).

Endoscopic resection (EMR / ESD)Barrett's oesophagusNon-endoscopic screening for Barrett's oesophagus and early adenocarcinoma
Early (T1a, high-grade dysplasia)

Endoscopic resection (EMR/ESD) with radiofrequency ablation of residual Barrett's; oesophagectomy for T1b with high-risk features.

NCCN · Category 1 (endoscopic therapy for Tis/T1a)
Endoscopic resection (EMR / ESD)
Resectable locally advanced (cT2-4a or N+)

CROSS chemoradiation (carboplatin/paclitaxel + 41.4 Gy) then oesophagectomy for squamous and adenocarcinoma; perioperative FLOT for adenocarcinoma/GEJ (ESOPEC). Adjuvant nivolumab for residual disease after chemoradiation (CheckMate 577).

NCCN · Category 1 (preoperative chemoradiation; ad…
CROSSCheckMate 577FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)NivolumabCROSS chemoradiation → surgery → adjuvant nivolumab if residual disease
Clinical complete response after chemoradiation

Active surveillance with surgery on regrowth is a non-inferior option (SANO); requires intensive endoscopic and PET surveillance.

SANOActive surveillanceClinical complete response (cCR)
Unresectable locally advanced or cervical

Definitive chemoradiation (50-50.4 Gy with cisplatin/5-FU or carboplatin/paclitaxel); PD-1 blockade added in trials.

NCCN · Category 1 (definitive chemoradiation)
IMRT / IGRT (modern external beam)Platinum agents
Advanced squamous cell carcinoma, first line

Chemotherapy + pembrolizumab (KEYNOTE-590), nivolumab (CheckMate 648), or tislelizumab (RATIONALE-306, PD-L1 ≥1%); nivolumab + ipilimumab chemotherapy-free option; camrelizumab/sintilimab/toripalimab in China.

NCCN · Category 1 (PD-L1-positive)
KEYNOTE-590CheckMate 648RATIONALE-306ESCORT-1stPembrolizumabNivolumabIpilimumabTislelizumabCamrelizumab
Advanced adenocarcinoma, first line

As for gastric cancer: chemotherapy + pembrolizumab or nivolumab (PD-L1 CPS ≥5 or ≥1); trastuzumab-based therapy if HER2-positive; zolbetuximab if CLDN18.2-positive (GEJ eligible in SPOTLIGHT/GLOW).

KEYNOTE-590CheckMate 649TrastuzumabZanidatamabZolbetuximab
Second line, squamous cell carcinoma

Izalontamab brengitecan after PD-(L)1 + platinum (PANKU-Esophagus01, OS and PFS benefit, 2026; approval pending); otherwise taxane or irinotecan; nivolumab/pembrolizumab if IO-naive.

PANKU-Esophagus01 (BL-B01D1-305)Izalontamab brengitecan
Second line, adenocarcinoma

T-DXd if HER2-positive (DESTINY-Gastric04); ramucirumab + paclitaxel; CLDN18.2 ADC after CLARITY-Gastric 01.

DESTINY-Gastric04Trastuzumab deruxtecanRamucirumabCLARITY-Gastric 01
Palliation of dysphagia

Self-expanding metal stent, brachytherapy, or external beam radiation; nutritional support; early palliative care.

BrachytherapyIMRT / IGRT (modern external beam)

Subtypes & biomarkers

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Subtypes
  • Squamous cell carcinoma (upper/mid oesophagus; tobacco, alcohol; Asia and Africa)
  • Adenocarcinoma (distal oesophagus/GEJ; Barrett's, reflux, obesity; the West)
  • GEJ tumours by Siewert type (I treated as oesophageal, III as gastric)
  • HER2-positive adenocarcinoma (~15-20%)
  • PD-L1-high (CPS ≥10 or TAP ≥10%) tumours with greater immunotherapy benefit
  • Cervical oesophageal cancer (definitive chemoradiation, no surgery)
  • Early (T1a) disease amenable to endoscopic resection
Biomarkers clinicians test

Target prevalence in this cancer

History

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  1. 1913Torek performs the first successful oesophagectomy for cancer
  2. 1980Cisplatin/5-FU chemoradiation defined (RTOG 85-01 reported 1992)

    Definitive chemoradiation shown superior to radiation alone; 5-year OS 26% vs 0%.

    IMRT / IGRT (modern external beam)Platinum agents
  3. 1990Endoscopic mucosal resection for early oesophageal cancer (Japan)
    Endoscopic resection (EMR / ESD)
  4. 2006MAGIC: perioperative chemotherapy for GEJ adenocarcinoma
    Cytotoxic chemotherapy
  5. 2010ToGA includes GEJ adenocarcinoma: trastuzumab for HER2-positive disease
    ToGATrastuzumab
  6. 2012CROSS: neoadjuvant chemoradiation
  7. 2012CROSS: neoadjuvant chemoradiation becomes standard
    CROSS
  8. 2019PD-1 blockade second line: pembrolizumab (KEYNOTE-181) and nivolumab (ATTRACTION-3)
    PembrolizumabNivolumab
  9. 2021Checkpoint inhibitors first line
  10. 2021CROSS 10-year data; CheckMate 577 adjuvant nivolumab; KEYNOTE-590 and ESCORT-1st first-line chemo-IO
    CROSSCheckMate 577KEYNOTE-590ESCORT-1st
  11. 2022CheckMate 648: nivolumab + chemotherapy and nivolumab + ipilimumab approved; RATIONALE-306 reported
    CheckMate 648RATIONALE-306
  12. 2023SANO: active surveillance non-inferior after complete response
    SANO
  13. 2024Tislelizumab approved in the US (second-line ESCC, first-line gastric); ESOPEC favours FLOT over CROSS in adenocarcinoma
    TislelizumabFLOT (5-FU, leucovorin, oxaliplatin, docetaxel)
  14. 2025Tislelizumab first-line ESCC approval; CheckMate 577 final OS not significant; DESTINY-Gastric04 for HER2+ GEJ
    TislelizumabCheckMate 577DESTINY-Gastric04
  15. 2026Iza-bren phase 3 positive
    BL-B01D1-307
  16. 2026PANKU-Esophagus01: iza-bren improves OS in second-line ESCC; HERIZON-GEA-01 for HER2+ GEJ; CheckMate 648 five-year data
    PANKU-Esophagus01 (BL-B01D1-305)HERIZON-GEA-01CheckMate 648

Pipeline

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Phase 3Bispecific ADC
Izalontamab brengitecan
ApprovedBiparatopic bispecific antibody (HER2)
Zanidatamab · Ziihera
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
PANKU-Esophagus01 (BL-B01D1-305)SANOOrgan preservation as the default after complete response in oesophageal cancerNon-endoscopic screening for Barrett's oesophagus and early adenocarcinomaHERIZON-GEA-01CLARITY-Gastric 01MRD / molecular residual disease testingFAPI PETCROSS chemoradiation → surgery → adjuvant nivolumab if residual diseaseCheckMate 648

Open problems

  • Late presentation.
  • Squamous cell carcinoma lacks targets beyond EGFR/HER3.
  • Most patients present with advanced disease; no Western screening for squamous cancer and only trial-stage non-endoscopic screening for Barrett's.
  • Adjuvant nivolumab improves DFS but not significantly OS; who truly needs it (PD-L1, ctDNA) is unknown.
  • Squamous cell carcinoma has no validated molecular targets beyond PD-1 and, since 2026, EGFR/HER3 antigen delivery.
  • PD-L1-negative tumours derive little from chemo-immunotherapy; alternatives are lacking.
  • Whether adding PD-1 blockade to definitive chemoradiation improves cure remains unproven pending KEYNOTE-975 and SKYSCRAPER-07.
  • Organ preservation requires intensive surveillance and salvage surgery capacity that many centres lack.
  • Oesophagectomy carries high morbidity; centralisation and minimally invasive approaches are unevenly adopted.

Trials

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Recruiting now (live from ClinicalTrials.gov)

Recruiting trials near you · live from ClinicalTrials.gov
Oesophageal cancer
condition: esophageal cancer
Open on ClinicalTrials.gov →

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Landmark trials in OnCo

Add-AspirinBL-B01D1-307CheckMate 577CheckMate 648CheckMate 649CLARITY-Gastric 01CROSSDESTINY-Gastric04ESCORT-1stHERIZON-GEA-01KEYNOTE-590PANKU-Esophagus01 (BL-B01D1-305)RATIONALE-306SANOToGA

Expert centres

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Where the expertise is

Centres linked to this cancer in OnCo

Seeking a second opinion: ask your oncologist for a referral to a high-volume centre; most accept records and pathology by mail or telehealth. In the US, use the NCI's Find a Cancer Center tool or the nonprofit Cancer Commons, which navigates options for advanced cancers at no cost.

Questions to ask

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Bring to your appointment

Questions to ask your oncologist about Oesophageal cancer

Generated from this cancer's standard of care, biomarkers, and pipeline · 34 questions

Newly diagnosed

  1. What is my exact diagnosis, stage, and grade, and which tests established them?
    Why: Everything else follows from an accurate stage and subtype.
  2. Which biomarkers have been tested on my tumour (for example PD-L1, HER2, EGFR, Histologydetermines the pathway, PD-L1), and what were the results?
    Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
  3. Which subtype is my cancer, and does that change the recommended treatment?
    Why: Recognised subtypes for this cancer include Squamous cell carcinoma, Adenocarcinoma, GEJ tumours by Siewert type.
  4. Is germline (inherited) genetic testing recommended for me or my family?
    Why: Inherited variants can change treatment and matter for relatives.

Localised

  1. For my situation (localised), which of the standard options do you recommend and why?
    Why: Guideline options include: Neoadjuvant chemoradiation (CROSS) or perioperative FLOT → surgery → nivolumab if residual disease.
  2. Am I a candidate for Nivolumab, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced

  1. For my situation (advanced), which of the standard options do you recommend and why?
    Why: Guideline options include: Chemotherapy + pembrolizumab/nivolumab; iza-bren in trials.
  2. Am I a candidate for Pembrolizumab, Izalontamab brengitecan, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Prevention and screening

  1. For my situation (prevention and screening), which of the standard options do you recommend and why?
    Why: Guideline options include: Tobacco and alcohol control; endoscopic screening of high-risk populations in China and Japan (Lugol chromoendoscopy); surveillance of Barrett's oesophagus with ablation or resection of dysplasia; non-endoscopic capsule-sponge screening in trials (BEST4).

Early (T1a, high-grade dysplasia)

  1. For my situation (early (t1a, high-grade dysplasia)), which of the standard options do you recommend and why?
    Why: Guideline options include: Endoscopic resection (EMR/ESD) with radiofrequency ablation of residual Barrett's; oesophagectomy for T1b with high-risk features.

Resectable locally advanced (cT2-4a or N+)

  1. For my situation (resectable locally advanced (ct2-4a or n+)), which of the standard options do you recommend and why?
    Why: Guideline options include: CROSS chemoradiation (carboplatin/paclitaxel + 41.4 Gy) then oesophagectomy for squamous and adenocarcinoma; perioperative FLOT for adenocarcinoma/GEJ (ESOPEC). Adjuvant nivolumab for residual disease after chemoradiation (CheckMate 577).
  2. Am I a candidate for FLOT (5-FU, leucovorin, oxaliplatin, docetaxel), Nivolumab, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of CROSS and CheckMate 577 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Clinical complete response after chemoradiation

  1. For my situation (clinical complete response after chemoradiation), which of the standard options do you recommend and why?
    Why: Guideline options include: Active surveillance with surgery on regrowth is a non-inferior option (SANO); requires intensive endoscopic and PET surveillance.
  2. How do the results of SANO apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Unresectable locally advanced or cervical

  1. For my situation (unresectable locally advanced or cervical), which of the standard options do you recommend and why?
    Why: Guideline options include: Definitive chemoradiation (50-50.4 Gy with cisplatin/5-FU or carboplatin/paclitaxel); PD-1 blockade added in trials.

Advanced squamous cell carcinoma, first line

  1. For my situation (advanced squamous cell carcinoma, first line), which of the standard options do you recommend and why?
    Why: Guideline options include: Chemotherapy + pembrolizumab (KEYNOTE-590), nivolumab (CheckMate 648), or tislelizumab (RATIONALE-306, PD-L1 ≥1%); nivolumab + ipilimumab chemotherapy-free option; camrelizumab/sintilimab/toripalimab in China.
  2. Am I a candidate for Pembrolizumab, Nivolumab, Ipilimumab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of KEYNOTE-590 and CheckMate 648 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Advanced adenocarcinoma, first line

  1. For my situation (advanced adenocarcinoma, first line), which of the standard options do you recommend and why?
    Why: Guideline options include: As for gastric cancer: chemotherapy + pembrolizumab or nivolumab (PD-L1 CPS ≥5 or ≥1); trastuzumab-based therapy if HER2-positive; zolbetuximab if CLDN18.2-positive (GEJ eligible in SPOTLIGHT/GLOW).
  2. Am I a candidate for Trastuzumab, Zanidatamab, Zolbetuximab, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of KEYNOTE-590 and CheckMate 649 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Second line, squamous cell carcinoma

  1. For my situation (second line, squamous cell carcinoma), which of the standard options do you recommend and why?
    Why: Guideline options include: Izalontamab brengitecan after PD-(L)1 + platinum (PANKU-Esophagus01, OS and PFS benefit, 2026; approval pending); otherwise taxane or irinotecan; nivolumab/pembrolizumab if IO-naive.
  2. Am I a candidate for Izalontamab brengitecan, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of PANKU-Esophagus01 (BL-B01D1-305) apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Second line, adenocarcinoma

  1. For my situation (second line, adenocarcinoma), which of the standard options do you recommend and why?
    Why: Guideline options include: T-DXd if HER2-positive (DESTINY-Gastric04); ramucirumab + paclitaxel; CLDN18.2 ADC after CLARITY-Gastric 01.
  2. Am I a candidate for Trastuzumab deruxtecan, Ramucirumab, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of DESTINY-Gastric04 and CLARITY-Gastric 01 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Palliation of dysphagia

  1. For my situation (palliation of dysphagia), which of the standard options do you recommend and why?
    Why: Guideline options include: Self-expanding metal stent, brachytherapy, or external beam radiation; nutritional support; early palliative care.

Any stage

  1. Are there clinical trials I could join, for example of Izalontamab brengitecan, PANKU-Esophagus01 (BL-B01D1-305), SANO, Organ preservation as the default after complete response in oesophageal cancer?
    Why: Trials are how the next standard of care is set; asking early keeps options open.
  2. Would a second opinion at a high-volume centre change anything, and can you help arrange it?
    Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
  3. What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
    Why: Supportive care improves quality of life and helps patients complete treatment.
  4. I read that “Late presentation”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.
  5. I read that “Squamous cell carcinoma lacks targets beyond EGFR/HER3”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.

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Everything relevant

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Direct links plus the targets, companies, and technologies of this cancer's products.

technologies

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Active surveillanceAlcohol reduction, pricing and cancer warning labelsAnti-angiogenic therapyAntibody-drug conjugate (ADC)Aspirin for cancer prevention and adjuvant therapyBispecific ADCBispecific antibodiesBrachytherapyCoffee and tea intakeCompanion diagnosticsCytotoxic chemotherapyEndoscopic resection (EMR / ESD)Enhanced recovery (ERAS) and perioperative nutritionEnteral and parenteral nutrition supportFAPI PETGlobal oncology and access in low- and middle-income countriesImmune checkpoint inhibitorsImmunonutrition before cancer surgeryIMRT / IGRT (modern external beam)Monoclonal antibodiesMRD / molecular residual disease testingNutrition support and cachexia managementOncology nutrition assessment and medical nutrition therapyPlatinum agentsPrehabilitation before cancer surgeryRobotic & minimally invasive surgerySmoking cessation in cancer patientsTopoisomerase-I inhibitors (and ADC payloads)Vitamin D and omega-3 supplementation

targets

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Claudin 18.2CTLA-4EGFRHER2HER3PD-1PD-L1VEGF / VEGFR

drugs

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Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
Not mapped hereCytotoxic regimen
FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)
Not mapped hereFluoropyrimidine antimetabolite
Fluorouracil (5-FU) · Adrucil / Efudex
ApprovedMonoclonal antibody (anti-CTLA-4)
Ipilimumab · Yervoy
Phase 3Bispecific ADC
Izalontamab brengitecan
ApprovedMonoclonal antibody (anti-PD-1)
Nivolumab · Opdivo / Opdivo Qvantig (SC)
Not mapped hereThird-generation platinum (DACH-platinum)
Oxaliplatin · Eloxatin
ApprovedMonoclonal antibody (anti-PD-1)
Pembrolizumab · Keytruda / Keytruda Qlex (SC)
ApprovedMonoclonal antibody (anti-VEGFR2)
Ramucirumab · Cyramza
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
ApprovedMonoclonal antibody (anti-PD-1)
Toripalimab · Loqtorzi
ApprovedMonoclonal antibody (anti-HER2)
Trastuzumab · Herceptin (and biosimilars, Phesgo with pertuzumab)
ApprovedADC
Trastuzumab deruxtecan · Enhertu
ApprovedBiparatopic bispecific antibody (HER2)
Zanidatamab · Ziihera
ApprovedMonoclonal antibody (anti-Claudin 18.2)
Zolbetuximab · Vyloy

companies

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AstellasAstraZenecaBeOne Medicines (formerly BeiGene)Bristol Myers SquibbDaiichi SankyoEli Lilly (incl. Loxo)Jazz PharmaceuticalsJiangsu Hengrui PharmaceuticalsMerck & Co. (MSD)Roche / GenentechSanofiSOFIE BiosciencesSystImmune / Sichuan BiokinZymeworks

institutions

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Aichi Cancer CenterAustralasian Gastro-Intestinal Trials GroupCancer Hospital, Chinese Academy of Medical SciencesCancer Institute of Iran, Imam Khomeini Hospital ComplexCancer Research UK Cambridge Centre / CRUK Cambridge InstituteChang Gung Memorial HospitalCharlotte Maxeke Johannesburg Academic Hospital / University of the WitwatersrandChinese Society of Clinical OncologyGroote Schuur Hospital / University of Cape TownHenan Cancer HospitalJapan Clinical Oncology Group (JCOG)Keio University HospitalKenyatta National HospitalKyushu University HospitalNational Cancer Center HospitalNational Cancer Center Hospital EastNetherlands Cancer Institute (NKI-AvL)Ocean Road Cancer InstituteOsaka International Cancer InstitutePeking University Cancer HospitalSahlgrenska University Hospital / Sahlgrenska Center for Cancer ResearchShandong Cancer Hospital and InstituteShanghai Chest HospitalSun Yat-sen University Cancer CenterWellcome Sanger InstituteZhejiang Cancer Hospital

pathways

4
Basement membrane & tissue barriersField cancerisationPD-1 / PD-L1 immune checkpoint & T-cell activationRAS / RAF / MEK / ERK (MAPK)

terms

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AdenocarcinomaAlcohol-attributable cancerBarrett's oesophagusBarrett's oesophagus (Barrett's metaplasia)Chemoradiation (chemoradiotherapy, CRT)Clinical complete response (cCR)Combined positive score (CPS)Dysphagia (difficulty swallowing)Dysplasia (pre-cancerous change)EMR and ESD (endoscopic mucosal resection, endoscopic submucosal dissection)Endoscopy (EGD, EUS, ERCP)Feeding tube (gastrostomy, PEG, jejunostomy)FLOT regimen (perioperative chemotherapy for gastric cancer)GastrectomyGastro-oesophageal junction (GEJ)MediastinumNeoadjuvant / adjuvant / perioperativeNutrition impact symptomsObesity-related cancers (IARC list of 13)OesophagectomyPathologic complete response (pCR)Siewert classification (GEJ tumours)Squamous cell carcinomaSquamous cell carcinoma (SCC)Squamous cell carcinoma vs adenocarcinoma of the oesophagusStenting (biliary, oesophageal, airway)

trials

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Add-AspirinBL-B01D1-307CheckMate 577CheckMate 648CheckMate 649CLARITY-Gastric 01CROSSDESTINY-Gastric04ESCORT-1stHERIZON-GEA-01KEYNOTE-590PANKU-Esophagus01 (BL-B01D1-305)RATIONALE-306SANOToGA

pairings

1
CROSS chemoradiation → surgery → adjuvant nivolumab if residual disease

ideas

24
A biomarker-directed trial of vitamin D after surgery for digestive tract cancersA dietitian in every gastrointestinal and head and neck tumour boardA funded programme of organ-preservation trials to avoid radical surgeryA swallowable sponge test for reflux patients, offered in pharmaciesA ten-dollar blood test for the five cancers that kill most people in poorer countriesBurden-matched funding for trials led in low- and middle-income countriesBurden-weighted portfolio targets for every major cancer funderCancer warnings on alcohol labels, evaluated as a natural experimentDedicated cohorts for patients with performance status 2 in first-line trialsDose-finding in older and frail patients, not extrapolation from fit onesEvaluate alcohol minimum unit pricing against cancer incidenceFour weeks of training and nutrition before major cancer surgery, as standardIntercept cancer at the field stageLink bariatric and GLP-1 registries to cancer registries in every country that has bothMinimum alcohol pricing evaluated with cancer endpointsNon-endoscopic screening for Barrett's oesophagus and early adenocarcinomaOpen-source drug discovery to clinical proof of concept for neglected cancersOrgan preservation as the default after complete response in oesophageal cancerPartial lottery funding for good proposals in under-funded cancersPooled coverage-with-evidence for proton therapy across all centresPre-surgery platform trials that test combinations on pathological response in monthsPublic risk-adjusted outcome reporting for cancer surgery to drive centralisationStop routine endoscopies for non-dysplastic Barrett's oesophagusUpfront reduced-dose regimens tested head-to-head in frail older patients

collections

2
CSCO guidelines (China)Japanese oncology guidelines (JSMO, JSCO and organ societies)

people

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David CunninghamHaruhiko FukudaJie HeJing HuangRui-Hua XuYelena Y. JanjigianYuko Kitagawa

bottlenecks

8
Cachexia, toxicity and the limits of the patientFragmented care and guideline gapsFunding follows fashion, not burdenMost lethal cancers are found lateMost of the world has almost no cancer carePain relief and palliative care are unavailable to mostPrevention we already have is not deployedSurgery and radiotherapy cure most, get least

key papers

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Alcohol caused an estimated 741,000 cancers worldwide in 2020CheckMate 649: nivolumab plus chemotherapy as first treatment for advanced gastric, gastro-oesophageal junction and oesophageal adenocarcinomaFifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it backIARC verdict: excess body fat causes 13 cancersSPOTLIGHT: zolbetuximab, the first Claudin 18.2 antibody, added to chemotherapy in gastric cancer

Key papers

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rctThe Lancet 2023changed practice
SPOTLIGHT: zolbetuximab, the first Claudin 18.2 antibody, added to chemotherapy in gastric cancer

Patients with newly diagnosed advanced stomach cancer should now have Claudin 18.2 tested alongside HER2, PD-L1 and mismatch repair, because roughly a third will be eligible for zolbetuximab, which adds about three months of median survival. The main practical problem is nausea and vomiting during infusions, which needs aggressive prophylaxis. How to sequence or combine it with immunotherapy in PD-L1-positive tumours is unresolved.

observationalLancet Oncology 2021
Alcohol caused an estimated 741,000 cancers worldwide in 2020

There is no safe level of alcohol for cancer risk, and the risk is highest for cancers of the mouth, throat, oesophagus, liver, bowel and breast. Public awareness is low; most people do not know alcohol causes breast cancer. Warning labels and minimum pricing are the policy levers being debated.

rctThe Lancet 2021changed practice
CheckMate 649: nivolumab plus chemotherapy as first treatment for advanced gastric, gastro-oesophageal junction and oesophageal adenocarcinoma

Patients with newly diagnosed advanced stomach or oesophageal adenocarcinoma whose tumour is HER2-negative and PD-L1 positive (CPS 5 or more, or at least 1 in some regions) should receive chemotherapy with nivolumab (or pembrolizumab, from KEYNOTE-859), which adds about three months of median survival and doubles the chance of being alive at three years. The benefit in PD-L1-negative tumours is doubtful, and these patients may be better served by chemotherapy alone or by trials.

reviewNew England Journal of Medicine 2016changed practice
IARC verdict: excess body fat causes 13 cancers

Maintaining a healthy weight is now established cancer prevention for over a dozen cancer types. For clinicians and policymakers, obesity belongs alongside tobacco and alcohol in prevention strategy. Whether intentional weight loss in adulthood reverses risk is still being studied, including in trials of GLP-1 drugs.

observationalBMJ 2004changed practice
Fifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it back

Smoking is the single largest preventable cause of cancer death, and quitting at any age helps, with the greatest gain from quitting young. Cessation support belongs in every cancer service, including lung screening programmes.

Latest papers

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Query for this cancer: (TITLE:"Oesophageal cancer" OR ABSTRACT:"Oesophageal cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Oesophageal cancer, not a curated reading list.

Connected

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Pages like this

not linked directly; found by shared links

technologies

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Active surveillanceAlcohol reduction, pricing and cancer warning labelsAntibody-drug conjugate (ADC)Aspirin for cancer prevention and adjuvant therapyBispecific ADCBrachytherapyCoffee and tea intakeCytotoxic chemotherapyEndoscopic resection (EMR / ESD)Enhanced recovery (ERAS) and perioperative nutritionEnteral and parenteral nutrition supportFAPI PETGlobal oncology and access in low- and middle-income countriesImmune checkpoint inhibitorsImmunonutrition before cancer surgeryIMRT / IGRT (modern external beam)MRD / molecular residual disease testingNutrition support and cachexia managementOncology nutrition assessment and medical nutrition therapyPlatinum agentsPrehabilitation before cancer surgeryRobotic & minimally invasive surgerySmoking cessation in cancer patientsVitamin D and omega-3 supplementation

targets

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Claudin 18.2CTLA-4EGFRHER2HER3PD-1PD-L1VEGF / VEGFR

drugs

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Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
Not mapped hereCytotoxic regimen
FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)
Not mapped hereFluoropyrimidine antimetabolite
Fluorouracil (5-FU) · Adrucil / Efudex
ApprovedMonoclonal antibody (anti-CTLA-4)
Ipilimumab · Yervoy
Phase 3Bispecific ADC
Izalontamab brengitecan
ApprovedMonoclonal antibody (anti-PD-1)
Nivolumab · Opdivo / Opdivo Qvantig (SC)
Not mapped hereThird-generation platinum (DACH-platinum)
Oxaliplatin · Eloxatin
ApprovedMonoclonal antibody (anti-PD-1)
Pembrolizumab · Keytruda / Keytruda Qlex (SC)
ApprovedMonoclonal antibody (anti-VEGFR2)
Ramucirumab · Cyramza
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
ApprovedMonoclonal antibody (anti-PD-1)
Toripalimab · Loqtorzi
ApprovedMonoclonal antibody (anti-HER2)
Trastuzumab · Herceptin (and biosimilars, Phesgo with pertuzumab)
ApprovedADC
Trastuzumab deruxtecan · Enhertu
ApprovedBiparatopic bispecific antibody (HER2)
Zanidatamab · Ziihera
ApprovedMonoclonal antibody (anti-Claudin 18.2)
Zolbetuximab · Vyloy

companies

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AstraZenecaBeOne Medicines (formerly BeiGene)Bristol Myers SquibbDaiichi SankyoJazz PharmaceuticalsJiangsu Hengrui PharmaceuticalsMerck & Co. (MSD)SOFIE BiosciencesSystImmune / Sichuan Biokin

institutions

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Aichi Cancer CenterAustralasian Gastro-Intestinal Trials GroupCancer Hospital, Chinese Academy of Medical SciencesCancer Institute of Iran, Imam Khomeini Hospital ComplexCancer Research UK Cambridge Centre / CRUK Cambridge InstituteChang Gung Memorial HospitalCharlotte Maxeke Johannesburg Academic Hospital / University of the WitwatersrandChinese Society of Clinical OncologyGroote Schuur Hospital / University of Cape TownHenan Cancer HospitalJapan Clinical Oncology Group (JCOG)Keio University HospitalKenyatta National HospitalKyushu University HospitalNational Cancer Center HospitalNational Cancer Center Hospital EastNetherlands Cancer Institute (NKI-AvL)Ocean Road Cancer InstituteOsaka International Cancer InstitutePeking University Cancer HospitalSahlgrenska University Hospital / Sahlgrenska Center for Cancer ResearchShandong Cancer Hospital and InstituteShanghai Chest HospitalSun Yat-sen University Cancer CenterWellcome Sanger InstituteZhejiang Cancer Hospital

pathways

4
Basement membrane & tissue barriersField cancerisationPD-1 / PD-L1 immune checkpoint & T-cell activationRAS / RAF / MEK / ERK (MAPK)

terms

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AdenocarcinomaAlcohol-attributable cancerBarrett's oesophagusBarrett's oesophagus (Barrett's metaplasia)Chemoradiation (chemoradiotherapy, CRT)Clinical complete response (cCR)Combined positive score (CPS)Dysphagia (difficulty swallowing)Dysplasia (pre-cancerous change)EMR and ESD (endoscopic mucosal resection, endoscopic submucosal dissection)Endoscopy (EGD, EUS, ERCP)Feeding tube (gastrostomy, PEG, jejunostomy)FLOT regimen (perioperative chemotherapy for gastric cancer)GastrectomyGastro-oesophageal junction (GEJ)MediastinumNeoadjuvant / adjuvant / perioperativeNutrition impact symptomsObesity-related cancers (IARC list of 13)OesophagectomyPathologic complete response (pCR)Siewert classification (GEJ tumours)Squamous cell carcinomaSquamous cell carcinoma (SCC)Squamous cell carcinoma vs adenocarcinoma of the oesophagusStenting (biliary, oesophageal, airway)

trials

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Add-AspirinBL-B01D1-307CheckMate 577CheckMate 648CheckMate 649CLARITY-Gastric 01CROSSDESTINY-Gastric04ESCORT-1stHERIZON-GEA-01KEYNOTE-590PANKU-Esophagus01 (BL-B01D1-305)RATIONALE-306SANOToGA

pairings

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CROSS chemoradiation → surgery → adjuvant nivolumab if residual disease

ideas

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A biomarker-directed trial of vitamin D after surgery for digestive tract cancersA dietitian in every gastrointestinal and head and neck tumour boardA funded programme of organ-preservation trials to avoid radical surgeryA swallowable sponge test for reflux patients, offered in pharmaciesA ten-dollar blood test for the five cancers that kill most people in poorer countriesBurden-matched funding for trials led in low- and middle-income countriesBurden-weighted portfolio targets for every major cancer funderCancer warnings on alcohol labels, evaluated as a natural experimentDedicated cohorts for patients with performance status 2 in first-line trialsDose-finding in older and frail patients, not extrapolation from fit onesEvaluate alcohol minimum unit pricing against cancer incidenceFour weeks of training and nutrition before major cancer surgery, as standardIntercept cancer at the field stageLink bariatric and GLP-1 registries to cancer registries in every country that has bothMinimum alcohol pricing evaluated with cancer endpointsNon-endoscopic screening for Barrett's oesophagus and early adenocarcinomaOpen-source drug discovery to clinical proof of concept for neglected cancersOrgan preservation as the default after complete response in oesophageal cancerPartial lottery funding for good proposals in under-funded cancersPooled coverage-with-evidence for proton therapy across all centresPre-surgery platform trials that test combinations on pathological response in monthsPublic risk-adjusted outcome reporting for cancer surgery to drive centralisationStop routine endoscopies for non-dysplastic Barrett's oesophagusUpfront reduced-dose regimens tested head-to-head in frail older patients

collections

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CSCO guidelines (China)Japanese oncology guidelines (JSMO, JSCO and organ societies)

people

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David CunninghamHaruhiko FukudaJie HeJing HuangRui-Hua XuYelena Y. JanjigianYuko Kitagawa

bottlenecks

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Cachexia, toxicity and the limits of the patientFragmented care and guideline gapsFunding follows fashion, not burdenMost lethal cancers are found lateMost of the world has almost no cancer carePain relief and palliative care are unavailable to mostPrevention we already have is not deployedSurgery and radiotherapy cure most, get least

key papers

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Alcohol caused an estimated 741,000 cancers worldwide in 2020CheckMate 649: nivolumab plus chemotherapy as first treatment for advanced gastric, gastro-oesophageal junction and oesophageal adenocarcinomaFifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it backIARC verdict: excess body fat causes 13 cancersSPOTLIGHT: zolbetuximab, the first Claudin 18.2 antibody, added to chemotherapy in gastric cancer