First targeted treatment to boost survival for esophageal cancer

Patients with a specific type of esophageal cancer survived longer when they were given the latest lung cancer drug, according to trial results presented at the 2014 National Cancer Research Institute Cancer Conference (NCRI).

Up to 1 in 6 patients with esophageal cancer were found to have EGFR duplication in their tumor cells and taking the drug gefitinib, which targets this fault, boosted their survival by up to 6 months, and sometimes beyond.

This is the first treatment for advanced esophageal cancer shown to improve survival in patients whose initial course of chemotherapy treatment has failed. It is also the first time a targeted treatment of any kind has proved effective in this disease, although chemotherapy and some targeted drugs have shown benefit in the second line treatment of other cancers of the digestive system including stomach cancer.

The trial, called 'TRANS-COG,' looked for extra copies of a gene called EGFR in tumor samples from 295 deceased esophageal cancer patients who had received either gefitinib or placebo as part of the COG trial.

Of the 48 patients who had extra EGFR copies in their tumor cells, 13% of those who had gefitinib survived for at least 1 year, while none of the patients who received a placebo survived that long.

Giving gefitinib to patients who did not have extra EGFR copies made no difference to how long they survived. This suggests that EGFR testing could identify a subgroup of esophageal patients who may benefit from gefitinib.

"This is exciting news in our field. It's the first time any drug has shown survival benefit for esophageal patients who have stopped responding to their initial treatment. To date there's been disappointingly little progress in treating this cancer type, which kills nearly 8,000 people a year and sadly is often diagnosed late making it difficult to treat successfully,” said presenter Russell Petty, MD, a medical oncologist from the University of Aberdeen in Scotland.

"It's thought that up to 16% of esophageal cancer patients could benefit from gefitinib, providing valuable extra months of life to people who would otherwise have had very few options available to them," added Petty.

"Although the survival benefit for these patients was relatively modest, this trial is an important step forwards for a type of cancer where progress in treatment has fallen behind other cancers in recent decades. While there has been some success in treating other cancers of the digestive system, esophageal cancer remains extremely difficult to treat, with only 13% of patients surviving 5 years or more,” said Professor Matt Seymour, MD, NCRI clinical research director.

"It will be interesting to see whether this drug, if properly targeted at the right patients, could offer similar benefits to those with earlier stage disease and also whether other drugs that target EGFR could prove to be even more effective."

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