Targeted drug therapy for esophageal cancer

Esophageal cancer is one of the common malignant tumors of the digestive system. The treatment trend of esophageal cancer is to rationally combine surgery, chemotherapy, radiotherapy and other treatment methods. Scientists are trying to treat esophageal cancer with molecular targeted drugs, which have high selectivity and have better effects when used in combination with conventional chemotherapy and radiotherapy. The combined treatment of molecular targeted drugs is a new direction for the comprehensive treatment of esophageal cancer.

1. Targeted therapy of epidermal growth factor receptor: Epidermal growth factor receptor (EGFR) is a type I transmembrane tyrosine kinase growth factor receptor, which is the expression product of proto-oncogene C-erbB-1. It can regulate cell growth, differentiation, angiogenesis and apoptosis. Its signaling pathway is closely related to the growth, invasion and metastasis of malignant tumors. Most epithelial malignancies have overexpression of EGFR, among which 40% to 80% of esophageal cancer patients have high expression of EGFR.
2. Tumor angiogenesis inhibitors: Vascular endothelial growth factor (VEGF) and its receptor (VEGFR-1) play an important role in inducing angiogenesis. Anti-angiogenesis therapy may become another potential therapeutic target for esophageal cancer.
3. Cell cycle inhibitors Cyclin-dependent kinase inhibitors: Cell cycle inhibitors Cyclin-dependent kinases (CDKs) are a family of proteins that regulate the cell cycle. In tumor tissues, "overactivation" of CDKs leads to uncontrolled cell proliferation.
4. Cyclooxygenase-2 (COX-2) inhibitors: The exact mechanism of action of COX-2 in tumor occurrence and development has not yet been fully elucidated. Possible mechanisms include inducing tumor angiogenesis, promoting tumor cell proliferation, inhibiting cell apoptosis, increasing the invasiveness of tumor cells, immunosuppressive effects, and inducing the activity of pro-carcinogens.
5. Other targeted therapeutic drugs: Other targets and representative targeted therapeutic drugs include Bcr-Abl tyrosine kinase inhibitors such as imatinib, mTOR kinase inhibitors such as Temsirolimus (cell cycle inhibitor 779, CCI-779), farnesyl transferase inhibitors (FTI) such as Tipifarnib, etc., which are gradually being used in the treatment of esophageal cancer. Their efficacy still needs to be confirmed by further clinical trial results.
Clinical research on targeted therapy for esophageal cancer is still in its infancy. Preliminary clinical studies suggest that tyrosine kinase inhibitors have a certain effect, cetuximab has the effect of sensitizing chemoradiotherapy, and bevacizumab combined with chemotherapy may improve the disease control rate of esophageal adenocarcinoma. How to achieve the best effect by combining targeted drugs with multiple targets, especially monoclonal antibodies combined with new cytotoxic drugs and combined with radiotherapy, is the focus of future research and is expected to push the treatment of esophageal cancer to a new stage, thereby prolonging the survival of patients with esophageal cancer and improving their quality of life.