Updated tips, treatment options, FDA news and more

April 23, 2022

5 minute read


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Esophageal cancer is one of the deadliest forms of cancer with an estimated 19,260 diagnoses and 15,530 deaths in the United States last year, the American Association for Cancer Research reported.

Although 2021 yielded FDA and European Commission approvals for nivolumab with chemotherapy for the treatment of gastric and esophageal cancers, regardless of PD-L1 expression status, and pembrolizumab with chemotherapy for cancers advanced HER2 negative disease burden remains high.

Esophageal cancer signs, symptoms and risk factors

The AACR reminds patients and providers of the common signs and symptoms of esophageal cancer, including painful or difficult swallowing, weight loss, pain behind the breastbone, hoarseness or coughing, indigestion and heartburn. Additional risk factors include smoking, heavy drinking, and Barrett’s esophagus, as well as older age, male gender, and African American ancestry.

Throughout April, Esophageal Cancer Awareness Month highlights the importance of early detection and intervention. Healio has compiled ten recent reports on FDA news, common conditions, updated guidelines, and treatment options.

FDA Accepts Supplemental Biologics License Application for Dupixent for EoE

Regeneron Pharmaceuticals Inc. and Sanofi announced that the FDA has accepted for priority review a Supplemental Biologics License Application for Dupixent 300 mg for adults and children ages 12 and older with eosinophilic esophagitis.

“This news is very welcome and encouraging, as there are no FDA-approved medications for eosinophilic esophagitis, and there is a large unmet need,” Evan S. Dellon, MD, MPH, professor in the Department of Medicine, Division of Gastroenterology and Hepatology at the University of North Carolina School of Medicine and co-principal investigator of the pivotal trials, Healio told Healio. “EoE is a chronic, progressive inflammatory disease that causes damage and remodeling of the esophagus. This ultimately places a heavy burden on patients, for whom swallowing food can be difficult, painful and worrisome. approved, dupilumab would be the first drug indicated for the treatment of EoE in the United States and has the potential to reduce underlying inflammation and help improve patients’ ability to swallow.

VIDEO: What’s in a name? How a precancerous esophageal condition got Barrett’s name

In this Endo-Sketch, a series of Healio videos on clinical conditions named after famous colleagues, Klaus Mergener, MD, from the University of Washington School of Medicine, discusses the origin of Barrett’s esophagus.

According to Mergener, the condition is named after British surgeon Norman Rupert Barrett, who was born in Adelaide, Australia, in 1903 and attended Eton and Trinity colleges in the UK. He joined St. Thomas’ Hospital in London after his medical studies to pursue postgraduate training in surgery and remained there throughout his career. Read more.

CAG updates guidance for diagnosis and management of Barrett’s esophagus

The CAG has released revised clinical guidelines for the diagnosis and management of patients with Barrett’s esophagus, which were published in the American Journal of Gastroenterology.

The guidelines implement the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology to provide 21 recommendations for the definition and diagnosis of EB, screening for EB and esophageal adenocarcinoma (EAC), monitoring and treatment. Of note, the updates expand acceptable screening modalities to include non-endoscopic methods, liberalized intervals for screening, and volume criteria for therapy centers. Read more.

Is FDA approval in sight for emerging EoE therapies?

Over the years, there have been many advances in the pathological understanding of eosinophilic esophagitis, but FDA-approved treatment options have lagged.

In a review published in the Journal of Allergy and Clinical Immunology, the researchers noted that current treatments are considered off-label and include the three Ds: drugs, dietary elimination, and endoscopic dilation. Read more.

A new risk model predicts the complexity of treating EB after radiofrequency ablation

According to research published in Clinical gastroenterology and hepatology.

“Endoscopic eradication therapy (EET) is well established for Barrett’s disease with early neoplasia. EET typically consists of endoscopic resection of visible abnormalities, followed by radiofrequency ablation (RFA),” Sanne van Munster, MD, from the Department of Gastroenterology and Hepatology at University Medical Centers Amsterdam, and colleagues wrote. “This dual modality treatment has been shown to be safe and results in complete eradication of EB (CE-BE) in 74% to 98% of patients. … However, a subgroup of patients will experience more complex treatment . Read more.

New ACG, CAG guidelines for antithrombotic treatment in acute gastrointestinal bleeding, periendoscopy

The CAG and the Canadian Association of Gastroenterology have developed recommendations for the management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the elective periendoscopic period.

“Our goal was to bring together experts in clinical content and methodology from gastrointestinal endoscopy and gastrointestinal bleeding, hematology and cardiology to create pragmatic, principle-based guidance related to the management of antiplatelet and anticoagulant drugs before endoscopy and in the setting of gastrointestinal bleeding”, Neena S. Abraham, MD, MSc (Epi), FCAE, from the Mayo Clinic in Scottsdale, Arizona, Healio told. “In this important update, we critically appraised the published literature regarding the temporary discontinuation and resumption of these agents and the use of reversal agents. Clinicians can have confidence in our recommendations based on the unprecedented rigor used in literature review and the multidisciplinary perspective addressing common clinical scenarios. Read more.

Long-term PPI therapy: “deprescribing” or continuing at the lowest effective dose, advises an expert

According to a Guild 2022 expert, physicians should “rethink” their approach to the long-term use of proton pump inhibitors and consider evidence-based recommendations regarding its known indications, benefits and risks.

“There is a wealth of information about proton pump inhibitors – not just for us, but also for our patients,” Doug A. Corley, MD, PhD, researcher at Kaiser Permanente of Northern California and clinical professor of medicine at the University of California, San Francisco, said during the presentation. Read more.

Nivolumab outperforms chemotherapy in treating esophageal squamous cell carcinoma

According to research, first-line treatment with nivolumab in patients with advanced esophageal squamous cell carcinoma resulted in longer overall survival compared to chemotherapy alone.

“Although chemotherapy has been a widely used first-line treatment for decades, clinical benefit has recently been reported with inhibitors of programmed death 1 (PD-1) in combination with chemotherapy compared to chemotherapy alone,” yuichiro Horsedoctor, from Osaka University Graduate School of Medicine, and his colleagues wrote in the New England Journal of Medicine. “Treatment with the anti-PD-1 monoclonal antibody nivolumab has been reported to result in significantly longer overall survival than chemotherapy in previously treated patients with advanced esophageal squamous cell carcinoma and is approved for this indication, regardless of programmed death ligand 1 (PD-L1) expression status.

Camrelizumab, apatinib safe, effective in advanced esophageal squamous cell carcinoma

Camrelizumab plus apatinib could potentially be used as a second-line treatment for advanced esophageal squamous cell carcinoma, according to phase 2 results published in The Lancet Gastroenterology and Hepatology.

“Second-line or later-line therapy with apatinib, a selective tyrosine kinase inhibitor of VEGF [receptor 2]showed antitumor activity in patients with advanced esophageal squamous cell carcinoma, with acceptable toxicity,” Xiangrui Meng, of the First Affiliated Hospital of Zhengzhou University in China, and his colleagues wrote. “A phase 1 study recommended apatinib at a dose of 250 mg in combination with camrelizumab in advanced cancers. Phase 2 studies of camrelizumab plus apatinib have been conducted in numerous solid tumors with encouraging efficacy and manageable safety. ” Read more.

Budesonide Improves Histological Symptom Response in Pediatric EoE

Budesonide oral suspension improved histological, endoscopic and symptomatic response compared to placebo in pediatric patients with eosinophilic esophagitis, according to one study.

“Budesonide Oral Suspension (BOS) is a swallowed immediate-release topical corticosteroid optimized as a viscous suspension for patients with EoE”, Sandeep K. Gupta, MD, of the Department of Gastroenterology, Hepatology, and Nutrition at Indiana University School of Medicine, and colleagues wrote. “Previous studies have shown that BOS improves symptomatic, histological, and endoscopic outcomes in adolescents and adults with EoE.” Read more.

Resources:

American Association for Cancer Research. Esophageal Cancer Awareness Month. Available at: https://www.aacr.org/patients-caregivers/awareness-months/esophageal-cancer-awareness-month/#:~:text=April%20is%20Esophageal%20Cancer%20Awareness%20Month. Accessed: April 20, 2022.

Cancer Research Institute. Esophageal Cancer Awareness Month: 2022 Immunotherapy Research Updates. Available at: https://www.cancerresearch.org/en-us/blog/april-2022/esophageal-cancer-awareness-month-2022-immunothera. Accessed: April 20, 2022.

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