Targeted and immunotherapy drugs for oesophageal cancer

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.

Some drugs work in more than one way. So they are targeted as well as working with the immune system. 

The main targeted drugs and immunotherapy for oesophageal cancer are:

• nivolumab (Opdivo)
• pembrolizumab (Keytruda)
• trastuzumab (Herceptin or Ontruzant)

When you might have targeted and immunotherapy drugs for oesophageal cancer

Whether you have targeted therapy depends on:

• the type of oesophageal cancer you have
• how far the cancer has grown (the stage)
• other treatments you've already had
• whether your cancer has changes (mutations) in certain proteins or genes

Tests on your cancer cells

Your doctor might test your cancer cells for particular proteins. This can help to show whether certain drug treatments might work for your cancer.

To test your cancer cells, your specialist needs a sample (biopsy) of your cancer. They might have tested your cancer cells when you were first diagnosed. Or they might be able to test some tissue from a biopsy or operation you have already had. 

In some cases, you might need to have a second biopsy.

To help decide on treatment for your oesophageal cancer, your doctor may look for:

• large amounts of a protein called HER2 receptor (HER2 positive cancer) 
• large amounts of  a protein called PD-L1 (PD-L1 positive cancer)

Types of targeted and immunotherapy drugs for oesophageal cancer

Nivolumab (Opdivo)

Nivolumab is a type of immunotherapy called a checkpoint inhibitor. It works by blocking the PD-L1 protein. This stops the immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells. 

You might have nivolumab on its own if:

• you still had cancer following chemoradiotherapy and you have now had surgery to completely remove the cancer
• or you have squamous cell cancer that has come back or spread to other parts of the body, and you have already had chemotherapy

You might have nivolumab with chemotherapy if:

• you have advanced adenocarcinoma or squamous cell cancer
• your cancer is PD-L1 positive
• you haven't had any other treatment for advanced cancer

Pembrolizumab (Keytruda)

Pembrolizumab is a type of immunotherapy called a checkpoint inhibitor. It stimulates the body's immune system to fight cancer cells. 

It targets and blocks a protein called PD-1 on the surface of certain immune cells called T-cells. Blocking the PD-1 protein triggers the T-cells to find and kill cancer cells. 

You might have pembrolizumab with chemotherapy for oesophageal cancer if:

• you can’t have surgery or your cancer is advanced
• your cancer is PD-L1 positive
• your cancer is HER 2 negative (low levels of the HER2 receptor)
• you haven't had any other treatment for advanced cancer

Trastuzumab (Herceptin or Ontruzant)

Trastuzumab has the brand name Herceptin. Or you might have a biosimilar such as Ontruzant. A biosimilar is a very similar copy of the original drug, but it is not exactly the same. Biosimilars undergo strict testing to check they work just as well as the original drug.

Trastuzumab is a monoclonal antibody. Monoclonal antibodies work by attaching to proteins on or in cancer cells.

Human epidermal growth factor receptor 2 (HER2) is a protein that makes cells grow and divide. 

Trastuzumab works by locking onto HER2 in the cancer cells. It both stops them from growing and kills them. Trastuzumab only works if your cancer is HER2 positive.

You might have it with chemotherapy for advanced cancer if:

• you have oesophageal adenocarcinoma
• your cancer is HER2 positive
• you haven't had any other treatment for advanced cancer

Having targeted and immunotherapy drugs

You have your treatment through a tube into your bloodstream.

Into the bloodstream

You have this treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Side effects

The side effects of targeted and immunotherapy cancer drugs are different depending on the drug you’re having. Not everyone gets all side effects.

The side effects you have depend on:

• which drug you have
• whether you have it alone or with other drugs
• the amount of drug you have (the dose)
• your general health

A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on. For more information about the side effects of your treatment, go to the individual drug pages.

Research into targeted and immunotherapy drugs for oesophageal cancer

Researchers are looking at different types of targeted and immunotherapy drugs for oesophageal cancer. Some of these are used to treat other cancers and some are new.

They are looking at these drugs on their own or combined with other treatments. 

When you go home

Treatment for oesophageal cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects you have. Your nurse will give you numbers to call if you have any problems at home.