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Adenocarcinoma of the lower oesophagus and junction grows out of Barrett's oesophagus, the change in the lining caused by long-standing acid reflux. Chemotherapy or chemoradiation before surgery is standard, and HER2, PD-L1 and claudin 18.2 now guide drugs for advanced disease as they do in stomach cancer.
Oesophageal adenocarcinoma arises in the lower oesophagus and gastro-oesophageal junction from Barrett's oesophagus, driven by reflux, obesity and smoking; TP53 mutation, chromosomal instability and amplification of HER2, EGFR, MET or KRAS are typical. Barrett's surveillance and endoscopic ablation or resection of dysplasia prevent progression. Locally advanced disease is treated with perioperative FLOT chemotherapy, which the ESOPEC trial showed gives better survival than CROSS chemoradiation, followed by oesophagectomy. Advanced disease is managed with stomach cancer regimens: nivolumab or pembrolizumab with chemotherapy for PD-L1-positive tumours, trastuzumab with chemotherapy for HER2-positive tumours, zolbetuximab for claudin 18.2-positive tumours, and trastuzumab deruxtecan after HER2-directed therapy.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Squamous cancers sit in the upper and middle oesophagus, adenocarcinomas at the junction and in the stomach; the stomach wall also gives rise to GIST from its pacemaker cells.
Same organ: Gastric & gastro-oesophageal junction cancer, HER2-positive gastric cancer, Claudin 18.2-positive gastric cancer, PD-L1-high gastric cancer, Microsatellite-unstable (MSI-high) gastric cancer, Early gastric cancer, Oesophageal squamous cell carcinoma, Oesophageal cancer, Gastrointestinal stromal tumour (GIST), KIT exon 11-mutant GIST, PDGFRA D842V-mutant GIST, Imatinib-resistant GIST
Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer.
Perioperative FLOT (docetaxel, oxaliplatin, fluorouracil, leucovorin) and oesophagectomy, preferred over CROSS after ESOPEC; chemoradiation where chemotherapy is not tolerated.
Nivolumab or pembrolizumab with platinum-fluoropyrimidine chemotherapy for PD-L1-positive tumours; trastuzumab with chemotherapy (and pembrolizumab) for HER2-positive tumours; zolbetuximab with chemotherapy for claudin 18.2-positive tumours.
Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil.
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Pembrolizumab plus chemotherapy is a first-line standard for advanced oesophageal cancer, with the strongest recommendation for PD-L1-expressing tumours.
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.
FLOT is the reference perioperative regimen for gastric and junctional adenocarcinoma, and the backbone onto which durvalumab was added in MATTERHORN.
CROSS chemoradiotherapy is a standard for locally advanced oesophageal cancer, particularly squamous cell carcinoma; for adenocarcinoma, perioperative FLOT is now often preferred after ESOPEC.
Query for this cancer: (TITLE:"Oesophageal and junctional adenocarcinoma" OR ABSTRACT:"Oesophageal and junctional adenocarcinoma" OR TITLE:"Esophageal adenocarcinoma" OR ABSTRACT:"Esophageal adenocarcinoma" OR TITLE:"EAC" OR ABSTRACT:"EAC" OR TITLE:"Gastro-oesophageal junction adenocarcinoma" OR ABSTRACT:"Gastro-oesophageal junction adenocarcinoma" OR TITLE:"Barrett's cancer" OR ABSTRACT:"Barrett's cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Oesophageal and junctional adenocarcinoma, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Capecitabine: take within 30 minutes after a meal. DPD deficiency (DPYD variants) causes severe toxicity: pre-treatment genotyping is recommended in Europe.
See all on the product pages:DocetaxelFLOT (5-FU, leucovorin, oxaliplatin, docetaxel)Fluorouracil (5-FU)NivolumabOxaliplatinPaclitaxel / nab-paclitaxelPembrolizumabRamucirumabTrastuzumab deruxtecan·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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