Blood Test Determines Esophageal Cancer Patient Treatment Options

A blood test that may be beneficial in indicating neoadjuvant treatment regimens for patients with esophageal squamous cell carcinoma has been introduced.

The blood test measures levels of two proteins found in the body, vascular endothelial growth factor-A (VEGF-A) and transforming growth factor-β1 (TGF-β1), indicate patients’ pathological response, and disease-free survival rates.

Scientists at the National Taiwan University Hospital (Taipei City, Taiwan) evaluated serum samples of 103 total patients with esophageal squamous cell carcinoma (ESCC) from 2004 to 2013. All patients received preoperative taxane-/5-fluorouracil-based chemotherapy (CCRT) and 40 gray (Gy) dose of radiation therapy prior to esophagectomy, the surgical removal of a part of the esophagus.

Serum samples were collected from patients before and within one month of completion of CCRT. The team used a proximity ligation assay (PLA) technique to screen for 15 serum biomarkers in 79 patients to evaluate the biomarkers’ association with pathological tumor regression on surgery and survival. The biomarkers significantly associated with pathological response (PathR) and survival rates were further analyzed by traditional enzyme-linked, immunosorbent assay (ELISA) to confirm initial biomarker findings by PLA in the total group of 103 patients.

The investigators found that patients with high VEGF-A were less likely to achieve complete tumor regression or a decrease in the size of a tumor or in the extent of cancer in the body, and that the survival rates were lower among patients who had high VEGF-A and high TGF-β1 levels before treatment. On ELISA, both pre- and post-CCRT VEGF-A levels were significantly correlated with PathR. Patients with pretreatment VEGF-A of less than 250 pg/mL showed a statistically significant pathologically complete response after CCRT (57.1%, or 20/35) compared to patients with VEGF-A of more than 250 pg/mL (26.5% or 18/68).

Jason Cheng, MD, the senior author of the study said, “Through the utilization of a specific blood test of serum biomarkers, we could potentially predict if a patient will have a favorable pathological response and outcome before radiotherapy. Treatment could be tailored for patients in order to achieve better outcomes and/or fewer side effects. Our study showed that the serum levels of VEGF-A and TGF-β1 were significant only before treatment. This would allow us to individualize the neoadjuvant treatment regimens based on the pretreatment serum levels of VEGF-A and TGF-β1.” The study was presented on September 14, 2014, at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting, held in San Francisco (CA, USA).

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