Advanced esophagogastric cancers: the making or breaking of a backbone

Esophageal cancer is the sixth leading causes of cancer mortality worldwide (1). In North America, adenocarcinoma has become the most common histology whereas squamous remains the most common histology worldwide. While the risk factors, tumor location, biology and prognosis of these two histologies differ, the treatment of these two types in the metastatic setting is the same. Unfortunately, most patients with either histology present with advanced disease at the time of diagnosis. Consensus is lacking as to the optimal first line chemotherapy regimen in the advanced or metastatic setting. Much of the data guiding the treatment of advanced esophageal cancer are extrapolated from trials in advanced gastric cancer and trials combining esophageal and gastric cancers. The National Comprehensive Cancer Network (NCCN) guidelines give a category 1 recommendation for doublet therapy combining fluorouracil or capecitabine and cisplatin for first line treatment for advanced esophageal and gastroesophageal junction (GEJ) carcinomas (2). However, several other chemotherapy combinations are also considered acceptable and are well tolerated.