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Gastroesophageal cancer: Navigating the immune and genetic terrain to improve clinical outcomes.
Cancer Treatment Reviews ( IF 11.8 ) Pub Date : 2019-12-10 , DOI: 10.1016/j.ctrv.2019.101950
James O Jones 1 , Elizabeth C Smyth 1
Affiliation  

Recent advances in our understanding of the molecular biology of gastric and oesophageal cancers have shown that gastroesophageal adenocarcinoma should be considered as one disease spectrum. Clinical management of these cancers is challenging, with poor outcomes in both early and late disease settings. Certain molecular subsets of gastroesophageal adenocarcinoma demonstrate features that suggest immunotherapy could be an effective treatment. Immunogenetic markers, including mismatch repair deficiency, PD-L1 status and tumour infiltrating lymphocytes influence overall prognosis. They may also determine the response to adjuvant and neoadjuvant conventional chemotherapy. Initial results from immunotherapy trials for gastroesophageal cancer have however been mixed, with poor overall responses in the first- and second-line settings. This review aims to discuss how better understanding of these immune and genetic interactions may lead to better selection of patients for conventional and immune based therapies, and therefore improve patient outcomes. We also discuss the challenges in implementing this new understanding in routine practice, and the current limitations of immune based treatments for gastroesophageal cancer.

中文翻译:

胃食管癌:在免疫和遗传领域中导航,以改善临床结果。

我们对胃癌和食道癌分子生物学的了解的最新进展表明,胃食管腺癌应被视为一种疾病。这些癌症的临床治疗具有挑战性,在早期和晚期疾病背景中结果均较差。胃食管腺癌的某些分子亚群表现出的特征表明免疫疗法可能是一种有效的治疗方法。免疫原性标志物,包括错配修复缺陷,PD-L1状态和肿瘤浸润淋巴细胞,都会影响总体预后。他们还可能确定对辅助和新辅助常规化疗的反应。然而,针对胃食管癌的免疫疗法试验的初步结果好坏参半,在一线和二线治疗中总体反应较差。这篇综述旨在讨论如何更好地理解这些免疫和遗传相互作用,从而可以更好地选择常规和基于免疫疗法的患者,从而改善患者的治疗效果。我们还将讨论在常规实践中实施这种新理解所面临的挑战,以及目前基于免疫的胃食管癌治疗方法的局限性。
更新日期:2019-12-11
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