Targeted therapy for esophageal cancer

Targeted therapy is sometimes used to treat esophageal cancer. It uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of targeted therapy. You may also receive other treatments.

Targeted therapy drugs are used to treat locally advanced or metastatic adenocarcinoma tumours at the gastroesophageal (GE) junction. They are usually combined with chemotherapy.

Trastuzumab is used with chemotherapy drugs to treat HER2-positive tumours. The most common combinations are:

• trastuzumab, cisplatin and fluorouracil
• trastuzumab, cisplatin and capecitabine (Xeloda)

If the cancer responds to treatment, trastuzumab may be given by itself after chemotherapy is finished. It is given until there are signs that the cancer has returned. This is called maintenance therapy.

Trastuzumab is not used to treat tumours that are HER2-negative. Research shows that it is not an effective treatment for these tumours.

Ramucirumab (Cyramza) is a monoclonal antibody that stops cells from using a substance called vascular endothelial growth factor (VEGF) to form new blood vessels. Without new blood vessels the cells don't get the oxygen and nutrients that they need to grow.

Ramucirumab is given in combination with paclitaxel.

Side effects can happen with any type of treatment for esophageal cancer, but everyone's experience is different. Some people have many side effects. Other people have few or none at all.

Targeted therapy attacks cancer cells but doesn't usually damage healthy cells, so there are usually fewer and less severe side effects than with chemotherapy or radiation therapy. Chemotherapy and radiation therapy can damage healthy cells along with cancer cells.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after targeted therapy. Sometimes late side effects develop months or years after targeted therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of targeted therapy will depend mainly on the type of drug or combination of drugs, the dose, and your overall health.

Targeted therapy may cause these side effects:

• flu-like symptoms, such as fever and chills
• low blood cell counts
• nausea and vomiting
• fatigue
• skin problems, including rash
• diarrhea
• headache
• poor wound healing (with ramucirumab)
• heart problems (with trastuzumab)

Tell your healthcare team if you have these side effects or others you think might be from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about targeted therapy. To make the decisions that are right for you, ask your healthcare team questions about targeted therapy.