Strategies for a Biomarker-Driven Approach to Locally Advanced Esophageal Cancer

Abstract Treatment paradigms for esophageal cancer are evolving and there is a growing need for prognostic and predictive biomarkers to guide clinical decision making. Perioperative chemotherapy has emerged as a standard of care for esophageal adenocarcinoma (EAC), yet some patients with an elevated local recurrence risk or poor tolerance to intensified chemotherapy may benefit from neoadjuvant therapy including radiation. Biomarkers for predicting treatment response to radiation, chemotherapy, and immunotherapy in other gastrointestinal malignancies and solid tumors are emerging that could be used to personalize treatment approaches. Recent trials have demonstrated the safety and efficacy of a watch-and-wait approach for both EAC and esophageal squamous cell carcinoma, but with pathologic complete response rates ranging from 10 to 49% it will be critical to improve patient selection for omission of surgery. Further prospective study is warranted to evaluate the clinical efficacy of a biomarker-driven treatment approach.