Precision Oncology in Gastro-Esophageal Adenocarcinoma

• Published in: Healthbook TIMES. Oncology Hematology Vol. 5; no. 5
• Main Authors: Marco Cefalì, Celeste Palmarocchi, Sara De Dosso
• Format: Journal Article
• Language: English
• Published: THE HEALTHBOOK COMPANY LTD 12.10.2020
• ISSN: 2673-2092; 2673-2106
• DOI: 10.36000/hbT.OH.2020.05.018

Gastro-esophageal adenocarcinomas (GEA) are a leading cause of cancer mortality, with limited therapeutic strategies available. With the advent of next-generation sequencing (NGS) and novel technologies, our understanding of its pathogenesis and molecular characterization continues to be improved, and new biomarkers have been identified. The onset and progression of gastric cancer has been attributed to multiple factors, including genetic alterations, epigenetic modifications, Helicobacter pylori, and Epstein-Barr Virus (EBV) infection, and dietary habits. These advances permit to integrate clinical, genetic, and epigenetic changes, and apply them to individual GEA patients in the era of precision medicine. Some biomarker-driven strategies are already part of consolidated clinical practice, proving the feasibility of this approach in principle, as is the case with the use of trastuzumab in human epidermal growth factor receptor 2 (HER2)-expressing GEA. Others, namely in the setting of immunotherapy and targeted therapy, are still investigational and require further study. The treatment of GEA is no longer defined by a “one size fits all” approach, and the definition of molecular subgroups amenable to individualized treatment strategies is likely the way forward. However, the lack of standardization and the multiplication of proposed classifications and biomarkers represents a significant obstacle to establishing a new paradigm. While small-scale experiences are undoubtedly of value and essential for hypothesis generation, appropriately powered prospective clinical trials are now urgently needed to translate these hypotheses in evidence-based practice. In this review, we will discuss the current and future potential biomarkers, drugs, and therapeutic approaches available for the management of GEA patients.