Trials & tribulations in oesophageal cancer

Date published: Feb 11 2020

Christopher M. Jones & Tom Crosby, on behalf of the National Cancer Research Institute Upper Gastrointestinal Oesophagogastric Subgroup

We have a great deal to learn about oesophageal cancer. In the United Kingdom, the number of patients diagnosed with this disease has grown by 6% over the past two decades and it is now the 14th most common cancer. Sadly, of the approximately 25 patient diagnosed with oesophageal cancer each day, only one in 10 will survive for 10 or more years. This is partly due to the late stage at which most cases are diagnosed, with seven in 10 patients already having developed advanced disease before they are told they have cancer. In contrast, when diagnosed early oesophageal cancer is curable and 80% of those diagnosed with early disease survive for more than one year. Nevertheless, a number of patients struggle with side effects from the treatment they receive, both whilst ‘on treatment’ and in the months and years afterwards.

We need then to ensure we are doing all we can to prevent patients developing oesophageal cancer, to diagnose it early when it does develop, and to find treatments that are both more effective and that result in fewer side effects. Fortunately, a good deal of progress has already been made in this regard. There have for instance been a number of studies focussed on finding new ways to diagnose this disease, and over the last decade the proportion of patients dying from oesophageal cancer has reduced by a tenth. It is anticipated that this improving trend will continue, with rates of death from oesophageal cancer projected to fall by a further 16% between 2014 and 2035.

Charities such as Cancer Research UK have designated oesophageal a cancer of unmet need indicating an intent to redouble its focus on trying to improve patient outcomes from this disease. In order to drive these further improvements, there needs to be more research to understand the ‘biology’ of oesophageal cancer, and there need to be more trials of strategies to prevent and treat it. One key aspect of these studies will be researching how the different forms of oesophageal cancer affect patients. We know for instance that rather than being one disease, oesophageal cancer in fact develops as one of two main forms. One of these, oesophageal adenocarcinoma (OAC), tends to affect the lower gullet and patients with this disease often first develop a precancerous condition called Barrett’s oesophagus. Conversely, cancers affecting the upper part of the gullet are usually cases of oesophageal squamous cell carcinoma (OSCC). A number of research studies in laboratories across the world are focussed on understanding how OAC and OSCC differ from one another, and for example which drugs are best for targeting each form. Outside of the laboratory, there are a large number of clinical trials focussed on finding new ways to prevent and treat both forms of this disease.

In the UK, the National Cancer Research Institute brings together clinicians, scientists, statisticians and lay representatives in ‘Research Groups’ to coordinate the development of these trials. One such Group – the ‘oesophagogastric subgroup’ – focusses on coordinating trials for cancers affecting the oesophagus and stomach. These include trials relating to disease prevention, such as the BEST3 trial, which is evaluating a new GP-based test for Barrett’s oesophagus and OAC in patients with heartburn symptoms. It also includes trials of improved treatments, like the SCOPE2 trial which is analysing the use of higher doses of radiotherapy in both forms of oesophageal cancer. Other trials overseen by the group include the use of new drugs, such as the use of a drug that activates the immune system in the LUD2015-005 study.

In future bulletins we will tell you you more about these and other studies overseen by our group. In doing so, we hope to highlight that whilst we do indeed have much we need to learn about oesophageal cancer, your generosity in taking part in trials means that we are together already doing a great deal to improve the way we prevent, diagnose and treat this disease.