Part UT Health San Antonio

Chemotherapy and targeted therapy are used to treat esophageal cancer. Chemotherapy uses drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body to the cancer cells. Targeted therapy uses medications to attack or block specific factors that help cancer cells grow.

Chemotherapy

Chemotherapy for esophageal cancer is most often used in combination with radiation therapy (called chemoradiation). When used alone, chemotherapy is not an effective treatment for esophageal cancer or long-term survival. Generally, any positive effects from chemotherapy treatment alone are short-lived.

Chemotherapy for esophageal cancer may given before or after surgery.

Chemotherapy Drugs and Delivery

There are a variety of chemotherapy drugs. Chemotherapy regimens for esophageal cancer have been found to work better when drugs are combined. The choice and combination of drugs will be based on your particular cancer and reaction to drugs. Chemotherapy drugs for esophageal cancer may include:

  • Fluorouracil (5-FU)
  • Cisplatin
  • Docetaxel
  • Paclitaxel
  • Epirubicin
  • Capecitabine
  • Carboplatin
  • Irinotecan
  • Methotrexate
  • Mitomycin
  • Vinorelbine
  • Oxaliplatin

Chemotherapy is most often given through an IV, but some forms can be given by mouth. It is delivered in cycles over a set period of time. A medical oncologist will determine how many cycles of chemotherapy are needed and what combination of drugs will work best.

Side Effects

Though the drugs are designed to target cancer cells, they can affect healthy cells as well. The death of cancer cells and impact on healthy cells can cause a range of side effects. A medical oncologist will work to find the best drug combination and dosage to have the most impact on the cancer cells and minimal side effects on healthy tissue. Side effects or complications from chemotherapy may include:

  • Numbness, pain, or burning sensation in the the hands and feet— peripheral neuropathy
  • Nausea and vomiting
  • Diarrhea or constipation
  • Fatigue due to anemia
  • Confusion, forgetfulness
  • More weight loss
  • Hearing loss
  • Kidney, liver, and/or heart damage

Targeted Therapy

Unlike chemotherapy, targeted therapy drugs attack cancer cells without harming healthy cells. They may work when standard chemotherapy drugs have not worked. Current targeted therapy options for esophageal cancer include trastuzumab and ramucirumab.

Certain esophageal cancers have an excess amount of a protein called human growth factor receptor (HER2). This protein spurs tumor growth. Trastuzumab, when used with chemotherapy, may help stop tumor growth in cancers with an excess amount of HER2. Side effects of the medication are fairly mild and include fever, weakness, nausea, diarrhea, and headache. It is sometimes associated with damage to heart muscle.

Ramucirumab is a second type of targeted therapy. This therapy blocks the development of new blood vessels that feed tumor growth. It is most often used to treat cancers where the stomach and esophagus meet. It may also be used when other medications have stopped working. The most common side effects include headache, high blood pressure, and diarrhea. This medication can also be associated with more serious side effects like difficulty with wound healing.

Managing Side Effects

A variety of treatments are available to help manage side effects including medication, lifestyle changes, and alternative treatments. In some cases, the chemo- and/or targeted therapy regimens may be adjusted to reduce severe side effects. The earlier the side effects are addressed, the more likely they will be controlled with a minimum of discomfort.

REFERENCES:

Esophageal and esophagogastric junction cancer. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114816/Esophageal-and-esophagogastric-junction-cancer. Updated January 18, 2016. Accessed January 3, 2017.

Esophageal cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/esophageal-cancer. Updated July 2014. Accessed January 3, 2017.

Esophagus cancer. American Cancer Society website. Available at http://www.cancer.org/acs/groups/cid/documents/webcontent/003098-pdf.pdf. Accessed January 3, 2017.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/_159. Updated July 19, 2016. Accessed January 3, 2017.

Last reviewed February 2021 by EBSCO Medical Review Board Mohei Abouzied, MD  Last Updated: 3/10/2021