59One hundred and sixty patients were given nivolumab alone or
two other different schedules of nivolumab plus ipilimumab, an
anti-CTLA4 monoclonal antibody. Response rate ranged from
10–26% and OS from 4.8–6.9 months. Clinically significant
treatment-related adverse events occurred in up to 35% of
patients in the combination arm and one death due to tumor
lysis syndrome was observed. The result suggested synergism of
the combination strategy but toxicity is the major concern. A
plethora of clinical studies with immunotherapy is currently
underway and results are eagerly awaited.2 Materials
- Trastuzumab.
- Ramucirumab.
- Nutritional assessment.
- Blood tests: complete blood count, liver and renal function
tests, tumor makers (e.g., carcinoembryonic antigen and
CA19.9) and hepatitis B serology. - Imaging: computed tomography of thorax, abdomen, and pel-
vis. Positron emission tomography is optional. - Endoscopic examination: tumor biopsy with esophagogastro-
duodenoscopy ± endoscopic ultrasound. - Cardiac assessment for those treated with trastuzumab: echo-
cardiogram or MUGA (multiple-gated acquisition) scan which
shows a moving image of heartbeat. - Determination of HER2 positivity by immunohistochemistry
staining or FISH (florescent in situ hybridization) before treat-
ment with trastuzumab (see Chapter 12 ). - Baseline blood pressure and proteinuria for those treated with
ramucirumab. - Blood tests: complete blood count, liver and renal function
tests, tumor makers if elevated at baseline (e.g., carcinoembry-
onic antigen and CA19.9). - Imaging: computed tomography of thorax, abdomen, and pel-
vis. Positron emission tomography is optional.
2.1 Target Therapy
2.1.1 Target Therapy
in First-Line Setting
2.1.2 Target Therapy
in Second-Line or
Beyond Setting
2.2 Investigations
2.2.1 Pretreatment
Investigations
2.2.2 On-Treatment
Investigations
Target Therapy of Esophageal Adenocarcinoma