[Wanqingyi Care]Esophageal cancer, chest pain, difficulty swallowing, immunity + chemotherapy to improve survival rate

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Text◆Chen Yingle (Clinical Assistant Professor, Department of Clinical Oncology, University of Hong Kong)

The esophagus is a tubular organ that connects the throat and stomach. It is about 25 to 30 centimeters long. It has no function of digesting food itself. It only sends food to the stomach for digestion through peristalsis.

A common symptom of esophageal cancer patients is difficulty swallowing, but patients often adjust their eating habits, such as chewing a bit before swallowing, and ignore treatment, which leads to worsening of the condition.

(Hong Kong News) According to data from the Hong Kong Cancer Statistics Center, in the past 10 years, there have been an average of about 410 new cases of esophageal cancer every year in Hong Kong, and more than 310 people died from esophageal cancer.

Mr. Wang, 74 years old, began to have difficulty swallowing 3 months ago and consulted a surgeon. A gastroscopy revealed a tumor in the esophagus, and tissue testing confirmed squamous esophageal cancer. He was referred to the oncology department. I suggested that he do a PET scan first to confirm whether the tumor had spread to other places before making the next treatment plan.

This also brings up the following questions:

The patient may experience vomiting blood and difficulty breathing

Ask:What are the symptoms of esophageal cancer?

Most patients with esophageal cancer experience difficulty swallowing in the early stages. However, patients often unconsciously change their eating habits, such as chewing a small amount before swallowing, or eating softer foods and ignoring treatment, which leads to worsening of the condition. Patients may also feel chest discomfort or pain when eating, or even vomit. Because patients are unable to eat normally, they may lose weight and become thinner. There are many important organs near the esophagus, such as the heart, lungs, trachea, aorta, etc. If the tumor is large, the patient may vomit blood, have difficulty breathing, etc.

Half of patients relapse 1 to 2 years after surgery

Ask:What can be done if esophageal cancer has not spread?

If the esophageal cancer is in the intermediate stage but has not spread, direct resection and radical surgery are not possible. The treatment method is to first perform chemotherapy and electrotherapy to shrink the tumor, and then arrange for surgical removal. However, even after surgery, the prognosis is not ideal, and more than half of patients still relapse 1 to 2 years after surgery.

In recent years, a phase III clinical study has proven that using immunotherapy as postoperative adjuvant treatment can help reduce tumor recurrence and metastasis in squamous esophageal cancer patients who have received chemotherapy and electrotherapy before surgery, but residual tumor cells are still found after surgery. risk.

In addition, research is being conducted internationally and in the Mainland to mix immunotherapy drugs and chemotherapy drugs as neoadjuvant therapy to shrink tumors before surgery. It is hoped that these studies can help patients with esophageal cancer.

If first-line chemotherapy is ineffective, switch to second-line chemotherapy

Q: If esophageal cancer has spread, is immunotherapy effective?

In the past, palliative chemotherapy was used to control esophageal cancer that has spread. Commonly used first-line chemotherapy drugs include cisplatin (cisplatin) and 5-fluorouracil (5-FU) as a mixed course of treatment, but the effect is not ideal and effective. The remission rate is about 30% to 40%, and the survival rate without worsening is about 4 to 5 months.

If first-line chemotherapy is ineffective, second-line chemotherapy drugs, such as paclitaxel, will be used. However, the treatment effect is not ideal, and the median survival rate is about 8 to 10 months.

In recent years, clinical studies have proven that immune checkpoint inhibitors (also known as immunotherapy) are helpful for patients with metastatic or recurrent esophageal squamous carcinoma. They can be mixed with chemotherapy for first-line treatment or used alone for second-line treatment.

1. First-line treatment

Currently, both international and mainland studies have shown that mixed immunotherapy and chemotherapy can more effectively control the disease and prolong life in patients with metastatic esophageal squamous carcinoma. For example: In the Keynote 590 study, 749 patients with metastatic advanced esophageal cancer were randomly assigned to two groups. One group received chemotherapy and the immune checkpoint inhibitor pembrolizumab, while the other group received chemotherapy alone. The results showed that if the patient’s tumor was positive for the immune checkpoint PD-L1, the progression-free survival of patients who received mixed treatment increased from 5.5 months to 7.5 months, and the overall survival also increased significantly, from 9.4 months to 13.5 months. months.

Another study is the Checkmate 648 study report published in the British Medical Journal in 2022, which confirmed that the use of the immune checkpoint inhibitor nivolumab (nivolumab) and chemotherapy in patients with advanced esophageal squamous cancer is better than just Chemotherapy drugs can more effectively control the disease. About 50% of the patients’ tumors shrank after taking the drugs, improving their survival rate without deterioration and extending their life span from 9.1 months to 15.4 months.

In addition, the mainland is also developing immune checkpoint inhibitors such as sintilimab, tislelizumab, camrelizumab, etc. for phase III studies, and the results are also very significant. , and is consistent with international research results, which is encouraging.

2. Second-line treatment

In addition to immunotherapy as first-line treatment, studies have also pointed out that immunotherapy alone as second-line treatment is more effective than paclitaxel chemotherapy in controlling the disease and prolonging the progression-free survival rate and overall survival rate.

Place a stent to open the esophagus to help patients eat

Ask:If esophageal cancer prevents you from eating, what methods can be used to solve the eating problem?

In addition to chemotherapy and immunotherapy, palliative electrotherapy can be used. The doctor will decide the number of times according to the patient’s needs, about 10 to 25 times. The surgeon can also use an endoscope to insert an esophageal stent to open up the position of the tumor obstruction and allow the patient to eat. .

The drug dosage will be adjusted according to the patient’s condition

Mr. Wang finally asked during the consultation whether he could withstand various treatments as he was older. I replied: “I believe age is not the biggest problem. We also need to look at the patient’s physical constitution and past health records to decide on medication and treatment.” In the treatment plan, the oncologist will also adjust the dosage of the drug according to the patient’s condition, hoping to achieve a balance between drug effects and side effects.”

Community Palliative Care App

Supporting home care for cancer patients

The “Home Support” community palliative care application is a project under the Department of Clinical Oncology of the University of Hong Kong.

“Home support” means “strengthening” family support. The app hopes to support cancer patients and their families in taking care of themselves at home, adding available resources for them to face cancer with a positive attitude; for example, ” Know More” provides cancer information, palliative care and hospice services to equip patients and caregivers with sufficient knowledge and skills to care for themselves at home.

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