At the Gastric and Esophageal Tumor Center of the Comprehensive Cancer Center Zurich, we offer a comprehensive range of services from diagnosis and treatment to aftercare for stomach and esophageal cancer. Depending on the type, location and extent, as well as patient-specific factors such as age and previous illnesses, stomach and esophageal cancer is treated surgically or with systemic therapy and radiotherapy. Sometimes a combination of these treatments is also necessary.
The systemic or drug treatment of gastric and esophageal cancer includes chemotherapy, immunotherapy and therapy with molecularly targeted substances.
Chemotherapy plays a central role in the treatment of stomach and esophageal cancer. If there is no distant metastasis, the treatment goal is complete healing. However, relapse rates are very high with surgery alone. With the exception of early stages, stomach and esophageal cancer is therefore pre-treated with chemotherapy or radiochemotherapy and then treated with chemotherapy or immunotherapy after the tumor has been completely removed. Patients with gastric carcinomas and deep-seated tumors of the junction between the esophagus and stomach receive 4 cycles (8 weeks) of chemotherapy before and after surgery. This “perioperative” chemotherapy reduces the risk of relapse and increases the chances of recovery. Therapy is based on the “FLOT protocol”, a combination of several substances that are administered by infusion.
If the tumor is located in the esophagus or at the entrance to the stomach, there are different strategies depending on the location and type of tissue. Adenocarcinomas located higher in the esophagus and most squamous cell carcinomas are pretreated with a combination of radiotherapy and chemotherapy over a period of 5 weeks, followed by surgery and finally, in many cases, immunotherapy (infusions with the antibody nivolumab) for up to a year. Pre- and post-treatment also reduce the risk of relapse here.
If gastric and esophageal cancer is so advanced that distant metastases are already present, cure is usually no longer possible and disease control and prolongation of life with the best possible quality of life are the treatment goals. At this stage of the disease, we carry out extensive molecular diagnostics on the tumor tissue in order to adapt the treatment to the tumor and patient as well as possible. Chemotherapy, immunotherapy and molecularly targeted therapy are used in the treatment. Combinations of chemotherapy, immunotherapy and/or molecularly targeted therapy (antibody infusions) are often used in the initial treatment.
Molecularly targeted therapies are either antibodies that are administered as an infusion and bind highly specifically to the surface of cancer cells or smaller molecules that are taken in tablet form, penetrate the cancer cells and interrupt metabolic processes. Depending on the molecular tumor profile, antibodies are most commonly used in gastric and esophageal cancer, which are combined with chemotherapy. The administration of trastuzumab, an antibody directed against the HER2 tumor protein, is effective in up to 20% of gastric and esophageal cancers. If the molecular tests reveal other molecular changes that can be addressed therapeutically, small molecules are sometimes also used.
Cancer immunotherapies, which are used for stomach and esophageal cancer, activate the body’s own immune cells (T cells) in a highly specific way, enabling them to destroy cancer cells more effectively. Anti-PD1 antibodies are used in particular for gastric and esophageal cancer. Depending on the individual tumor profile, these antibodies are administered alone or in combination with chemotherapy. However, not all gastric and esophageal cancers respond to immunotherapy, so molecular markers are used to determine in advance whether immunotherapy is promising or not.
At the Gastric and Esophageal Tumor Center, we offer the entire spectrum of screening, diagnostics, treatment and aftercare for gastric and esophageal cancer at all stages.
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University Hospital Zurich
Department of Medical Oncology and Hematology
Rämistrasse 100
8091 Zurich