Published online Aug 15, 2014. doi: 10.4291/wjgp.v5.i3.322
Revised: January 27, 2014
Accepted: April 25, 2014
Published online: August 15, 2014
Processing time: 252 Days and 18.2 Hours
Neoadjuvant therapy has been proven to be extremely valuable and is widely used for advanced esophageal cancer. However, a significant proportion of treated patients (60%-70%) does not respond well to neoadjuvant treatments and develop severe adverse effects. Therefore, predictive markers for individualization of multimodality treatments are urgently needed in esophageal cancer. Recently, molecular biomarkers that predict the response to neoadjuvant therapy have been explored in multimodal approaches in esophageal cancer and successful examples of biomarker identification have been reported. In this review, promising candidates for predictive molecular biomarkers developed by using multiple molecular approaches are reviewed. Moreover, treatment strategies based on the status of predicted biomarkers are discussed, while considering the international differences in the clinical background. However, in the absence of adequate treatment options related to the results of the biomarker test, the usefulness of these diagnostic tools is limited and new effective therapies for biomarker-identified nonresponders to cancer treatment should be concurrent with the progress of predictive technologies. Further improvement in the prognosis of esophageal cancer patients can be achieved through the introduction of novel therapeutic approaches in clinical practice.
Core tip: To achieve individualization of neoadjuvant therapy for locally advanced esophageal cancers, predictive biomarkers are urgently needed. Biomarker development using multimodal approaches, including gene expression profiling, single nucleotide polymorphisms, microRNAs, proteomics, immunohistochemistry, serum biomarkers and conventional blood tests, seem promising. Independent validation studies will establish novel prognostic modalities based on molecular biomarkers. Progress of predictive modalities and further studies on the molecular background of patients with a poor prognosis will facilitate the development of new effective therapies for patients resistant to the present neoadjuvant therapy. Prognostic stratification of patients will promote efforts toward novel therapeutic strategies.