Predicting Response to Neoadjuvant Therapy in Oesophageal Adenocarcinoma

Abstract

(1) Background: Oesophageal cancers are often late-presenting and have a poor 5-year survival rate. The standard treatment of oesophageal adenocarcinomas involves neoadjuvant chemotherapy with or without radiotherapy followed by surgery. However, less than one third of patients respond to neoadjuvant therapy, thereby unnecessarily exposing patients to toxicity and deconditioning. Hence, there is an urgent need for biomarkers to predict response to neoadjuvant therapy. This review explores the current biomarker landscape. (2) Methods: MEDLINE, EMBASE and ClinicalTrial databases were searched with key words relating to “predictive biomarker”, “neoadjuvant therapy” and “oesophageal adenocarcinoma” and screened as per the inclusion and exclusion criteria. All peer-reviewed full-text articles and conference abstracts were included. (3) Results: The search yielded 548 results of which 71 full-texts, conference abstracts and clinical trials were eligible for review. A total of 242 duplicates were removed, 191 articles were screened out, and 44 articles were excluded. (4) Discussion: Biomarkers were discussed in seven categories including imaging, epigenetic, genetic, protein, immunologic, blood and serum-based with remaining studies grouped in a miscellaneous category. (5) Conclusion: Although promising markers and novel methods have emerged, current biomarkers lack sufficient evidence to support clinical application. Novel approaches have been recommended to assess predictive potential more efficiently.

The Use of miRNAs in Predicting Response to Neoadjuvant Therapy in Oesophageal Cancer

“…Articles reviewing intratumoral miRNA concentrations are more useful in determining the functional mechanisms by which miRNA expression links to how patients respond to nChemo/nCRT. In addition to this, assessing miRNA expression in vitro often leads to differential results between samples due to the interplay between miRNA expression and the intratumoural microenvironment [ 49 , 75 ]. Based on this, future translational research must focus on the standardisation of miRNA sampling and extraction in circulating fluids, in order to become robust enough biomarkers to use in clinical practice.…”

The application of radiomics in esophageal cancer: Predicting the response after neoadjuvant therapy

“…To improve clinical prognosis and outcomes, NAT has also been introduced to the treatment of EC, especially for patients with locally advanced EC. The primary neoadjuvant therapies (NATs) for EC are neoadjuvant chemotherapy (nCT), neoadjuvant chemoradiotherapy (nCRT), and NAT combined with immunotherapy (60)(61)(62).…”

The Oesophageal Cancer Multidisciplinary Team: Can Machine Learning Assist Decision-Making?

“…12,13 Reliable predictive tools might then permit early triaging of non-responders directly to surgery in a bid to reduce NAT-associated morbidity and mortality for potentially little gain as it is recognised that NAT can decondition patients prior to surgery, potentially even rendering them inoperable. [14][15][16] OC patients are consequently reliant on high-quality decision-making in often complex clinical contexts, with significant implications for their outcomes and quality of life. 17 Currently, their treatment decisions are made by a multidisciplinary team (MDT), which is shown to improve patient outcomes.…”

“… 12 , 13 Reliable predictive tools might then permit early triaging of non-responders directly to surgery in a bid to reduce NAT-associated morbidity and mortality for potentially little gain as it is recognised that NAT can decondition patients prior to surgery, potentially even rendering them inoperable. 14 – 16 …”