Dr Barzi on the Evolution of Treating Gastroesophageal Cancers

Afsaneh Barzi, MD, PhD, director, AccessHope™, associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses challenges treating oncologists face when aiming to navigate the treatment landscape of patients with gastroesophageal cancers and highlights the evolution of treatments for patients with these diseases.

Oncologists face challenges in multiple areas when treating patients in this arena, Barzi begins. In years past, all esophageal gastric cancers were combined with one another when studied in clinical trials and treated in clinical practice, she explains. In current and future clinical trials investigating chemotherapy in patients with gastroesophageal cancers, the tumor histology, location, and presentation as either esophageal or gastric should all be considered, especially in the metastatic setting. Despite the importance of differentiating between tumor characteristics in these diseases, earlier clinical trials included all types of gastroesophageal cancers, Barzi says.

However, in the modern era of treating patients with these diseases, the development of targeted therapies has now led to the differentiation of these treatments by tumor histology, she expands. Now, oncologists can stratifypatients by tumor type. For example, investigators can differentiate a patient with squamous cell carcinoma from one with adenocarcinoma and further differentiate patients based on the locations of their tumors, such as esophageal vs gastroespohageal, Barzi emphasizes. Notably, some tumors are located higher up in the esophagus, whereas others are located closer to the stomach, Barzi adds.

Overall, the gastroesophageal cancers treatment paradigm is moving away from considering all these diseases as one, Barzi says. Instead, researchers are now separating them into different entities for the application of investigational data, which will in turn benefit patient outcomes, Barzi continues. Looking to the future, Barzibelieves that oncologists will stop combining certain subtypes of gastroesophageal cancer and will instead continue to determine the optimal therapies for each patient based on their individual disease characteristics.