Get information about the success rate, drugs used, and types of immunotherapies for esophageal cancer with our detailed guide!

When treating esophageal cancer with immunotherapy, antibodies are produced in a laboratory and injected into the body intravenously to determine the location of cancerous cells and help prevent their development.

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.

Why Is Immunotherapy Used to Treat Esophageal Cancer?

Drugs called immune checkpoint inhibitors target these checkpoint proteins, which can help restore the immune response against esophagus cancer cells.

Immunotherapy for esophageal cancer is being utilized to reduce recurrence, as a first-line treatment, and in novel combinations for advanced-stage cancer.

When Should Immunotherapy Treatment Be Used in Esophageal Cancer?

The two most common forms of esophageal cancer are squamous cell carcinoma, which begins in cells lining the esophagus, and adenocarcinoma, which begins in cells that make and release mucus and other fluids.

In the United States, adenocarcinoma is the most common form of the disease and is diagnosed primarily in older white men. Squamous cell carcinoma is more common outside of the United States, particularly in less developed countries.

Following several recent drug approvals by the Food and Drug Administration, immunotherapy—both alone and with chemotherapy—has become a standard treatment for some forms of esophageal cancer, noted Carmen Allegra, M.D., a special advisor to NCI’s Division of Cancer Treatment and Diagnosis.

“The new findings are important research results that will inform decisions about initial therapy for some patients with advanced esophageal cancers,” said Dr. Allegra, who specializes in the treatment of gastrointestinal cancers.

What Are the Types of Esophageal Cancer Immunotherapy?

For some people with advanced esophageal cancer, immunotherapy-based combination therapies are more effective than chemotherapy alone, which is the current standard treatment.

Immunotherapy is a class of treatments that take advantage of a person’s immune system to help kill cancer cells. There are six FDA-approved immunotherapy options for esophageal cancer.

Targeted Antibodies:

Ramucirumab: a monoclonal antibody that targets the VEGF/VEGFR2 pathway and inhibits tumor blood vessel growth; approved for subsets of patients with advanced gastroesophageal cancer

Trastuzumab: a monoclonal antibody that targets the HER2 pathway; approved for subsets of patients with advanced, HER2-positive gastroesophageal cancer, including as a first-line therapy

Trastuzumab deruxtecan: an antibody-drug conjugate that targets the HER2 pathway; approved for subsets of patients with advanced gastroesophageal cancer

Immunomodulators:

Dostarlimab: a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced esophageal or gastroesophageal cancer that has DNA mismatch repair deficiency (dMMR)

Nivolumab: a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced esophageal or gastroesophageal cancer

Pembrolizumab: a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced esophageal or gastroesophageal cancer

Immunotherapy research on esophageal cancer is ongoing and holds the promise of additional treatment options. Several other immunotherapy approaches for esophageal cancer have shown promise in early clinical trials.

What Are the Side Effects of Esophageal Cancer Immunotherapy Treatment?

Immunotherapy treats many types of cancer effectively. But like other cancer treatments, they are powerful medications that can cause changes within the body or to how you feel, called side effects. These side effects are different for everyone. They depend on the type of immunotherapy, the type of cancer, its location, your general health, and other factors.

Immunotherapy may also cause the immune system to attack healthy cells. This can cause side effects, also called “immune-related adverse events.” These may occur at any time during treatment or sometimes even after all cycles of immunotherapy are completed.

Different types of immunotherapies cause different side effects. That’s why it is important to talk with your doctor about the type of immunotherapy used for your cancer, the goals of treatment, and the potential side effects of your immunotherapy.

Common Side Effects of Esophageal Cancer Immunotherapies Can Include:

Feeling weak or tired
Muscle or joint pain
Loss of appetite
Constipation or diarrhea
Shortness of breath
Skin rash
Itching
Nausea
Cough
Fever

Other, more serious side effects happen less often. These can include:

Infusion Reactions: Some people might have an infusion reaction while getting one of these drugs. This is like an allergic reaction and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting one of these drugs.

Auto-immune Reactions: These drugs work by basically removing one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.

It’s very important to report any new side effects to your health care team promptly. If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.

What Is the Success Rate of Immunotherapy for Esophageal Cancer?

Researchers found that median overall survival was 9.3 months in immunotherapy tested groups compared to 6.7 months in the chemotherapy group. The 12-month overall survival rate was 43 percent in patients taking pembrolizumab (immunotherapy drug) compared to 20 percent in those receiving chemotherapy, a two-fold increase.

“Our results also show that pembrolizumab particularly benefits patients with squamous cell cancer,” said Dr. Shah. The median overall survival in patients with this form of esophageal cancer was 8.2 months with pembrolizumab versus 7.1 months with chemotherapy, while survival in all patients was 7.1 months.

Treatment-related adverse events occurred in 18.2 percent of the immunotherapy group versus 40.9 of the chemotherapy group. For example, fatigue, diarrhea, and low red and white blood cell counts, were more common in the chemotherapy group. “Immunotherapy has fewer side effects than chemotherapy, so not only did people survive longer, but they also survived longer with fewer side effects,” said Dr. Shah, who has been a paid consultant for Astellas Pharma and Eli Lilly and Company.

Clinical Trials for Esophageal Cancer

Esophageal cancer clinical trials offer access to new, innovative treatments that are not widely available but go through strict, FDA-approved regulatory processes before being approved for use. Massive Bio guides patients through the most comprehensive clinical trial matching process using our AI-Powered system. Participating in a clinical trial provides patients with treatment options they would otherwise not have access to.

Immunotherapy research on esophageal cancer is ongoing and holds the promise of treatment options. Several other immunotherapy approaches for esophageal cancer have shown promise in early clinical trials.

If you’ve been diagnosed with any of the following esophageal cancer subtypes, we’re here to help.