Esophageal Cancer: Targeted Therapy

What is targeted therapy?

Targeted therapy drugs attack specific proteins or cell functions that help cancer cells grow. Like chemo, these medicines work throughout the body. But they work in different ways. Because these medicines mainly target cancer cells, the side effects are often different and less severe than those from chemo.

What targeted therapy drugs are used to treat esophageal cancer?

At this time, two targeted drugs are approved for use to treat some esophageal cancers:

• Trastuzumab is a drug that targets HER2. This is a protein on cells that can help them grow. A small portion of cancers that start at the place where the esophagus meets the stomach (the gastroesophageal junction or GEJ) have too much of this protein. This helps them grow faster. This medicine can be used with chemo to help treat these cancers.

• Ramucirumab is a targeted medicine that works by blocking new blood vessels from forming around a tumor. Tumors need new blood vessels to grow beyond a certain size. 

When might targeted therapy be used to treat esophageal cancer?

Targeted therapy isn’t part of the main treatment for most people with esophageal cancer. But it might be used in some situations:

• Trastuzumab can be used along with chemo as the first treatment in people with advanced GEJ cancers that have too much of the HER2 protein. 

• Ramucirumab can be used (either alone or with chemo) in people with advanced GEJ cancers who have already had at least one other treatment.

How is targeted therapy given for esophageal cancer?

Before treatment starts, you’ll meet with a medical oncologist. This is a doctor who specializes in treating cancer with medicines. The doctor will discuss your treatment options with you and explain what you might expect. 

The targeted medicines used to treat esophageal cancer are given as an infusion into a vein (intravenous or IV). In most cases, you’ll receive it once every two or three weeks. They are normally given in an outpatient setting. That means that you get it at a hospital, clinic, or healthcare provider's office. Then you can go home after you receive the treatment. Less often, you may need to stay in the hospital during treatment.

Your healthcare provider will watch you for reactions during your treatments. Since each of your treatments may last for a while, you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

What are common side effects of targeted therapy?

Side effects of targeted therapy can vary based on which type of medicine you receive. Ask your healthcare provider for more details about possible side effects. Tell your healthcare provider about any changes or side effects you have. He or she can suggest things to make you feel better. In most cases, you’ll stop having side effects within a few weeks after your treatment ends.

Some of the side effects from trastuzumab include:

• Allergic reactions. If you have a reaction, it will likely be temporary and treatable. Your healthcare provider will decide if you can continue to receive this type of medication.

• Nausea and vomiting

• Diarrhea

• Fever

• Headache

• Cough

• Heart damage. This occurs more often when this drug is given with certain chemo drugs. Before treatment, your healthcare provider may check your heart function.

Some of the possible side effects from ramucirumab include:

• Allergic reactions. If you have a reaction, it will likely be temporary and treatable. Your healthcare provider will decide if you can continue to receive this type of medication.

• High blood pressure. Your healthcare provider can treat this with medicines.

• Increased chance of blood clotting. This raises your risk of heart attack and stroke. Your healthcare provider will watch you for this side effect. Tell your healthcare provider right away if you have chest pain, shortness of breath, numbness or weakness, or if you feel dizzy or faint. 

• Increased chance of an opening occurring in the stomach or intestine (gastrointestinal perforation). Tell your healthcare provider right away if you have any new pain, constipation, or vomiting.

• Increased chance for healing delay in surgical wounds. Let your healthcare provider know if you have wounds that aren’t healing well.

• Increased chance of bleeding inside your body. Tell your healthcare provider right away if you cough up blood, have blood in stools or urine, or bleeding from your nose or gums.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your health care team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.