Optimal management of gastroesophageal junction cancer

Abstract

Although recent decades have witnessed incremental improvements in the treatment of gastroesophageal junction (GEJ) carcinoma, outcomes remain modest. For locally advanced esophageal cancer, the addition of chemotherapy and/or radiation to surgery is considered the standard of care. Chemotherapy remains the primary treatment for metastatic disease and improves survival over best supportive care. However, the prognosis for patients with GEJ cancers, which are treated along the same paradigms as esophageal and gastric carcinomas, remain poor because of the emergence of chemoresistance and limited targeted therapeutic approaches, which include agents that target the HER2 and vascular endothelial growth factor pathways. Evaluation of immune checkpoint inhibitors in the chemorefractory setting have confirmed the activity of immunotherapy in esophagogastric cancer. Ongoing immunotherapeutic strategies are being evaluated in both the locally advanced and metastatic settings. This review focuses on the treatment of locally advanced and metastatic GEJ carcinomas, which encompass all tumors that have an epicenter within 5 cm proximal or distal to the anatomical Z‐line (Siewert classification). Because the vast majority of GEJ tumors are adenocarcinoma, the management of adenocarcinoma is the focus of this review. Evolving approaches and areas of clinical equipoise are discussed.

Prognostic Value of the Systemic Inflammation Response Index in Patients with Adenocarcinoma of the Oesophagogastric Junction: A Propensity Score-Matched Analysis

“…In recent years, the incidence of adenocarcinoma of the oesophagogastric junction (AEG) has increased significantly [1]. Due to the particularity of this tumour anatomy, there has been a lack of uniform definition and classification for a long time, and AEG has not been treated as an independent disease [1]. Clinical studies of AEG are relatively few, often including gastric cancer or oesophageal cancer.…”

“…In related studies, the results lack comparability. Therefore, substantial controversy remains in the choice of the best treatment plan for AEG [1]. With the introduction and practice of the Siewert classification theory [2], an increasing number of studies have regarded AEG as an independent disease.…”

Prognostic Significance of CIP2A in Esophagogastric Junction Adenocarcinoma: A Study of 65 Patients and a Meta-Analysis

“…The treatment strategy for EGJA is complex because of the anatomical location of the esophagogastric junction. The incidence of EGJA has shown an increasing trend over the past few decades with a poor prognosis [6, 7]. There is therefore an urgent need to reveal novel molecular markers to provide new strategies for EGJA treatment and improve patient outcomes.…”

Hyperprogression in PDL1 Expressive, Recurrent Gastroesophageal-junction Adenocarcinoma After Pembrolizumab

“…Esophageal cancers with an estimated incidence of over 570,000 cases a year worldwide represent around 3.2% of all newly diagnosed cancers [8]. In the USA, around 75% of these esophageal cancers are primarily accounted by adenocarcinomas arising at the GEJ and the distal esophagus [9]. While surgical options along with perioperative chemotherapy have been the mainstay for treatment, ICIs are recently being evaluated in refractory disease.…”