Treatment of Locally Advanced Esophageal Carcinoma

Rapid Recommendation Update

Published online August 3, 2021

This rapid recommendation provides timely guidance on the use of nivolumab.

2021 Updated Recommendation: Following neoadjuvant CRT and surgery, nivolumab should be offered to patients with locally advanced esophageal carcinoma with Eastern Cooperative Oncology Group status 0-1 who did not experience a pathological complete response (i.e., with residual disease of at least ypT1 or ypN1 in resected specimens). (Type: evidence-based; benefits outweigh harms; Evidence quality: moderate; Strength of recommendation: strong). 

Qualifying statements: 

• Note: Details regarding nivolumab following treatment with perioperative chemotherapy, and analysis of data in patients with high PD-L1 CPS will be available pending publication in the Journal of Clinical Oncology.

¹Kelly RJ, Ajani JA, Kuzdzal J, et al: Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer. N Engl J Med 384:1191-1203, 2021

2020 Guideline Abstract

Published online June 22, 2020, DOI: 10.1200/JCO.20.00866

Manish A. Shah, MD; Erin B. Kennedy, MHSc; Daniel V. Catenacci, MD; Dana C. Deighton; Karyn A. Goodman, MD; Narinder K. Malhotra, MD; Christopher Willett, MD; Brendon Stiles, MD; Prateek Sharma, MD; Laura Tang, MD, PhD; Bas P. L. Wijnhoven, MD, PhD; and Wayne L. Hofstetter, MD

Purpose

To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with locally advanced esophageal cancer.

Methods

ASCO convened an Expert Panel to conduct a systematic review of the more recently published literature (1999-2019) on therapy options for patients with locally advanced esophageal cancer and provide recommended care options for this patient population.

Results

Seventeen randomized controlled trials met the inclusion criteria. Where possible, data were extracted separately for squamous cell carcinoma and adenocarcinoma.

Recommendations

Multimodality therapy for patients with locally advanced esophageal carcinoma is recommended. For the subgroup of patients with adenocarcinoma, preoperative chemoradiotherapy or perioperative chemotherapy should be offered. For the subgroup of patients with squamous cell carcinoma, preoperative chemoradiotherapy or chemoradiotherapy without surgery should be offered. Additional subgroup considerations are provided to assist with implementation of these recommendations.

© 2021 American Society of Clinical Oncology, all rights reserved. For licensing opportunities, contact licensing@asco.org.

Guideline Disclaimer

The Clinical Practice Guidelines and Rapid Updates published herein are provided by the American Society of Clinical Oncology, Inc. (ASCO) to assist providers in clinical decision making. The information herein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. Recommendations specify the level of confidence that the recommendation reflects the net effect of a given course of action. The use of words like “must,” “must not,” “should,” and “should not” indicates that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Use of the information is voluntary. ASCO does not endorse third party drugs, devices, services, or therapies used to diagnose, treat, monitor, manage, or alleviate health conditions. Any use of a brand or trade name is for identification purposes only. ASCO provides this information on an “as is” basis and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information, or for any errors or omissions.