Targeted Therapy for Esophageal Cancer

As researchers have learned more about the changes in cells that cause cancer, they have been developed newer drugs that specifically target these changes. Targeted drugs work differently from standard chemotherapy drugs. They sometimes work when standard chemo drugs don’t, and they often have different side effects. They can be used either along with chemo or by themselves if chemo is no longer working.

Trastuzumab

A small number of esophagus cancers have too much of the HER2 protein on the surface of their cells, which can help cancer cells to grow. Having too much of this protein is caused by having too many copies of the HER2 gene.

A drug that targets the HER2 protein, known as trastuzumab (Herceptin), may help treat these cancers when used along with chemotherapy. If you have esophageal cancer and can’t have surgery, your doctor may have your tumor biopsy samples tested for the HER2 protein or gene. People whose cancers have normal amounts of the HER2 protein or gene are very unlikely to be helped by this drug.

Trastuzumab is injected into a vein (IV) once every 3 weeks along with chemo. The optimal length of time to give it is not yet known.

Most of the side effects of trastuzumab are relatively mild and can include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. These occur less often after the first dose. This drug can also sometimes cause heart damage, leading to the heart muscle becoming weak. This drug is not given with certain chemo drugs called anthracyclines, such as epirubicin (Ellence) or doxorubicin (Adriamycin), because it can further increase the risk of heart damage if they are given together. Before starting treatment with this drug, your doctor may test your heart function with an echocardiogram or a MUGA scan.

Ramucirumab

For cancers to grow and spread, they need to create new blood vessels so that the tumors get blood and nutrients. One of the proteins that tells the body to make new blood vessels is called VEGF. VEGF binds to cell surface proteins called receptors to act. Ramucirumab (Cyramza) is a monoclonal antibody that binds to a receptor for VEGF. This keeps VEGF from binding to the receptor and signaling the body to make more blood vessels. This can help slow or stop the growth and spread of cancer.

Ramucirumab is used to treat cancers that start at the gastroesophageal (GE) junction when they are advanced (the GE junction is the place where the stomach and esophagus meet). It is most often used after another drug stops working.

This drug is given as infusion into a vein (IV) every 2 weeks.

The most common side effects of this drug are high blood pressure, headache, and diarrhea. Rare but possibly serious side effects include blood clots, severe bleeding, holes forming in the stomach or intestines (called perforations), and problems with wound healing. If a hole forms in the stomach or intestine it can lead to severe infection and may require surgery to correct.

For more information about what to expect when taking these drugs, see Targeted Cancer Therapy.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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National Cancer Institute. Physician Data Query (PDQ). Esophageal Cancer Treatment. 2017. Accessed at www.cancer.gov/cancertopics/pdq/treatment/esophageal/HealthProfessional on May 6, 2017.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. V.1.2017. Accessed at www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf on May 6, 2017.

Posner MC, Minsky B, Ilson DH. Ch 45 - Cancer of the esophagus. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2015.

Last Medical Review: June 14, 2017 Last Revised: June 14, 2017

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