Predicting Response to Treatment in Gastroesophageal Junction Adenocarcinomas: Combining Clinical, Imaging, and Molecular Biomarkers

Abstract

After completing this course, the reader will be able to:1. Contrast the subtypes of gastroesophageal adenocarcinoma in order to select optimal therapeutic approaches for given subtypes.2. Compare the various tools (CT, MRI, PET, PET-CT, etc.) for evaluating response to therapy in order to determine whether to initiate new therapy.3. Evaluate response to neoadjuvant therapy, utilizing imaging, histopathogy of resected specimens, and biomarkers, to plan postoperative treatment.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe incidence of adenocarcinomas of the gastroesophageal junction (GEJ) is rapidly rising, and even in earlystage locoregional confined disease the 5-year survival rate rarely exceeds 25%-35%. Randomized trials and meta-analyses have demonstrated a benefit with neoadjuvant or perioperative chemotherapy and with neoadjuvant chemoradiotherapy. However, the optimal approach in individual patients is not clear and remains controversial. A consistent finding is that patients who have a histopathological response to neoadjuvant therapy are more likely to receive a survival benefit. These clinical data provide a strong argument for the urgent development of methods to predict histopathological response to neoadjuvant therapies for GEJ adeno- The Oncologist CME Program is located online at http://cme.theoncologist.com/.To take the CME activity related to this article, you must be a registered user. Gastrointestinal CancerThe

BAK is a predictive and prognostic biomarker for the therapeutic effect of docetaxel treatment in patients with advanced gastric cancer

“…Kaoru et al [42] examined FoxM1 expression in gastric cancer specimens before docetaxel treatment, showing a correlation with survival. However, as they did not assess histopathological responses and R0, which strongly affect disease progression [13,14], clinical outcomes after surgery remain obscure when compared with the results presented in this study.…”

“…No treatment-related deaths occurred, and the regimen was well tolerated; however, we did observe the occurrence of high-grade hematological toxicity, or non-hematological toxicity such as nausea, diarrhea, and stomatitis. The histopathological analysis of resected specimens from patients treated with preoperative chemotherapy has revealed valuable biomarkers for assessing survival benefits after surgery [13,14]. Predicting responses to cytotoxic drugs before initiating preoperative chemotherapy can potentially spare patients who are unlikely to respond to such treatment from the associated adverse effects.…”

The Metastasis-Associated Gene MTA3, a Component of the Mi-2/NuRD Transcriptional Repression Complex, Predicts Prognosis of Gastroesophageal Junction Adenocarcinoma

“…Owing to an alarming increase in incidence [1], [2], gastroesophageal junction (GEJ) adenocarcinoma was recently classified as a distinct pathologic entity [3]. As it is currently defined, GEJ adenocarcinoma encompasses tumors occurring within 5 cm proximal or distal to the gastroesophageal junction [3].…”

“…As it is currently defined, GEJ adenocarcinoma encompasses tumors occurring within 5 cm proximal or distal to the gastroesophageal junction [3]. GEJ adenocarcinoma is associated with a poor prognosis, with a 5-year overall survival (OS) rate of only 10–15%, largely owing to its rapid lymphatic and hematogenous metastasis [4]–[7].…”

“…GEJ adenocarcinoma is associated with a poor prognosis, with a 5-year overall survival (OS) rate of only 10–15%, largely owing to its rapid lymphatic and hematogenous metastasis [4]–[7]. Increasing evidence indicates that GEJ adenocarcinoma differs from gastric and esophageal cancers in both molecular and clinical aspects [3]. To date, mechanism of metastasis focused on GEJ adenocarcinoma is unclear and molecular markers for GEJ adenocarcinoma metastasis and tumor progression remain elusive; data from available studies are difficult to interpret because of the complexity arising from tumor heterogeneity (squamous vs .…”