An Ailment with Which I Will Contend: A Narrative Review of 5000 Years of Esophagogastric Cancers and Their Treatments, with Special Emphasis on Recent Advances in Immunotherapeutics
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Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
2
Internal Medicine Residency Program, University of Tennessee Health Sciences Center, 920 Madison Ave, Suite 531, Memphis, TN 38163, USA
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(3), 618; https://doi.org/10.3390/cancers16030618
Submission received: 22 November 2023
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Revised: 24 January 2024
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Accepted: 30 January 2024
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Published: 31 January 2024
(This article belongs to the Special Issue Role of Immunotherapy in Gastroesophageal Cancers: Advances, Challenges and Future Strategies)
Simple Summary
Cancers of the esophagus and stomach are among the most common and deadly cancers worldwide, and have been major contributors to human suffering throughout recorded history. This review traces the chronology of these cancers from 3000 BCE to the present. The first several thousand years were devoted to palliative operations, before advances in operative technique and technology led to the first curative surgery in 1913. Around the same time, in 1910, systemic therapies were introduced, and radiotherapy shortly thereafter. The later decades of the 20th century saw a groundswell of advances in surgery, endoscopic therapy, systemic therapy, and radiotherapy, and, from the 1970s, an increasing focus on combination approaches. While studies in these areas continued to advance, immunotherapies became a major new category in the late 2010s. An increasing number of immunotherapies have been developed and now encompass more indications and earlier lines of therapy. As standards of care incorporate these effective yet expensive therapies, care must be given to disparities and methods for increasing access.
Abstract
Esophagogastric cancers are among the most common and deadly cancers worldwide. This review traces their chronology from 3000 BCE to the present. The first several thousand years were devoted to palliation, before advances in operative technique and technology led to the first curative surgery in 1913. Systemic therapies were introduced in 1910, and radiotherapy shortly thereafter. Operative technique improved massively over the 20th century, with operative mortality rates reducing from over 50% in 1933 to less than 5% by 1981. In addition to important roles in palliation, endoscopy became a key nonsurgical curative option for patients with limited-stage disease by the 1990s. The first nonrandomized studies on combination therapies (chemotherapy ± radiation ± surgery) were reported in the early 1980s, with survival benefit only for subsets of patients. Randomized trials over the next decades had similar overall results, with increasing nuance. Disparate conclusions led to regional variation in global practice. Starting with the first FDA approval in 2017, multiple immunotherapies now encompass more indications and earlier lines of therapy. As standards of care incorporate these effective yet expensive therapies, care must be given to disparities and methods for increasing access.
