My Treatment Approach: The Evolving Treatment Landscape of Esophageal Squamous Cell Carcinoma - Episode 2
Shared insights on contemporary approaches to treating localized ESCC and existing racial disparities in treatment.
John Marshall, MD: If the patient has localized disease with no evidence of spread, maybe lymph nodes in the region, the common strategy is giving a combination of chemotherapy and radiation. The classic regimen that we use is called the CROSS regimen, but there’s also platinum and fluoropyrimidine, which is commonly given. The CROSS regimen is carbo-Taxol given weekly; it’s a pretty easy regimen. You can also give platinum and fluoropyrimidine with radiation. This is long-course radiation, 5 to 6 weeks. That can have a fairly significant response, and for some patients that’s the definitive treatment. Think head and neck a little further south, where the goal is to try to avoid a surgical approach in those patients. Of course, with chemoradiation, it’s not definitive in many patients. When possible, we sometimes will also do a surgical resection. In patients who have residual disease after that surgical resection, there are times when you give more adjuvant therapy with the advent of immunotherapy in that space in patients who’ve had curative intent chemoradiation, surgery, and residual disease followed by immunotherapy.
Esophageal cancer, squamous cell cancers of the esophagus, are seen in 50-, 60-, 70-year-old people. They’re seen in White people, in Black people, in other races around the world, and in other ethnicities. What we’re looking at, increasingly, is that not everyone has the same outcome. A recent paper from Samantha Savitch looked at this. It was published in the Journal of Gastrointestinal Surgery. Itdemonstrated that African Americans had a worse outcome than non–African Americans. It’s not clear that there’s a biological reason for this, but it’s likely more of an access to treatment. Because this is a complicated disease, it does require multidisciplinary care. It takes a village. Not everybody has a good village on their side. Particularly in patients who are part of more vulnerable populations, regardless of race, make sure to step up your game as a treatment team because we can level the playing field by helping those patients.
Transcript edited for clarity.