Dr. Botta on the Diagnosis and Treatment of ESCC

Gregory Botta, MD, PhD, a medical oncologist and an associate professor of medicine at the University of California, San Diego (UCSD) Health, Moores Cancer Center at UCSD, discusses the diagnosis and treatment of patients with esophageal squamous cell carcinoma (ESCC).

Patients with ESCC may initially seek treatment due to trouble or pain with swallowing, dysphasia, or weight loss. Patients may also experience excess salivation or regurgitation of food. Additionally, some patients may experience hoarseness due to the disease’s local invasion around the vocal cords. Moreover, some patients will be diagnosed from a laboratory analysis that is conducted due to chronic blood loss and anemia associated with ESCC, Botta explains. When a symptomatic patient seeks care, the priority is to refer the patient for assessment by a gastroenterologist, who can perform an esophagogastroduodenoscopy (EGD), Botta continues.

However, approximately 5% to 10% of patients with ESCC are asymptomatic, according to Botta, who adds that a diagnosis of ESCC may be made only because a patient happened to receive an EGD or another scan.

When a patient is diagnosed with ESCC, it is important to note that this histology differs from esophageal adenocarcinoma, Botta explains. When a patient is diagnosed with ESCC, clinicians look for PD-L1 expression with the tumor proportion score (TPS) or the combined positive score (CPS), which could serve as indicators to how well a given patient may respond to treatment. However, chemoimmunotherapy is generally the standard of care for patients with ESCC, irrespective of PD-L1 status, Botta notes. although.

Although there are some instances where immunotherapy may not be combined with chemotherapy, most patients with ESCC are responsive to immunotherapy, even without a high expression of PD-L1. A longer or more robust response could be expected from the addition of immunotherapy for patients with a higher PD-L1 TPS or CPS, Botta concludes.