Esophageal Cancer: Targeted Therapy

What is targeted therapy?

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

What targeted therapy medicines are used to treat esophageal cancer?

At this time, 2 targeted medicines are approved for use to treat some esophageal cancers:

  • Trastuzumab is a medicine that targets the HER2 protein. HER2 is found on the surface of cells and can help them grow. It helps them grow faster.

  • 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 to treat a small number of esophageal cancers that start at the place where the esophagus meets the stomach (the gastroesophageal junction or GEJ):

  • 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. Tumors are tested to see if they have too much HER2 before this medicine is used.

  • Ramucirumab can be used (either alone or with chemo) in people with advanced GEJ cancers who have had at least one other treatment that didn't work.

How is targeted therapy given for esophageal cancer?

Before treatment starts, you’ll meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines. He or she 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 (IV or intravenous). In most cases, you’ll get it once every 2 or 3 weeks 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 treatment. Rarely, you may need to stay in the hospital during treatment.

Your healthcare provider will watch you for reactions during the treatments. Since each treatment 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, like a book or mobile device.

What are common side effects of targeted therapy?

Side effects of targeted therapy 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. There are often things that can be done to help you feel better. In most cases, you’ll stop having side effects within a few weeks after treatment ends.

Some of the side effects from trastuzumab include:

  • Allergic reactions. If you have a reaction, it will likely be short-term and treatable. Reactions most often happen with the first dose. Your healthcare provider will then decide if you can continue to get this medicine.

  • Nausea and vomiting

  • Diarrhea

  • Fever

  • Headache

  • Cough

  • Heart damage. This occurs more often when this medicine is given along with certain chemo medicines. 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 medicine.

  • High blood pressure. This can be treated 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 holes opening in the stomach or intestine (called gastrointestinal perforation). Tell your healthcare provider right away if you have any new pain, constipation, or vomiting.

  • Problems with wound healing. 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 healthcare 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.

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