Immunotherapy Treatment for Advanced Esophageal Cancer

Immuno-oncology (or immunotherapy) and precision medicine are the newest developments in the treatment of advanced cancer.  Immuno-oncology helps to restore the body’s immune system and improves outcomes when administered alone or in combination with chemotherapy.

Immunotherapy is class of treatments that take advantage of a person’s own immune system to help kill cancer cells. There are currently several FDA-approved immunotherapy options for the treatment of esophageal cancer.

Precision medicine

Precision medicine drugs may be used to treat stage 4 adenocarcinoma tumors at the gastroesohageal junction. They are usually combined with chemotherapy.

Trastuzumab is used with chemotherapy drugs to treat HER2 positive tumours. The most common combinations are:

  • trastuzumab, cisplatin and fluorouracil
  • trastuzumab, cisplatin and capecitabine


Ramucirumab (Cyramza) is a monoclonal antibody that stops cells from using a substance called vascular endothelial growth factor (VEGF), which helps cells form new blood vessels. Without new blood vessels the cells don’t get the oxygen and nutrients that they need to grow. Ramucirumab is given in combination with paclitaxel.


Immunotherapy may be used for stage 4 esophageal cancer.

Pembrolizumab (Keytruda) may be offered in combination with cisplatin and fluorouracil as the first treatment for:

  • squamous cell carcinoma of the esophagus
  •  HER2 negative esophageal tumours found at the gastroesophageal junction


Nivolumab (Opdivo) may be offered for stage 4A esophageal cancer if surgery was done to remove the tumor. It may also be offered to people who still have cancer remaining after chemo, radiation and surgery.

Nivolumab may be given in combination with either cisplatin and fluorouracil or carboplatin and fluorouracil for tumors at the gastroesophageal junction or adenocarcinoma tumors.

The goal of immunotherapy is to help the immune system recognize and eliminate cancer cells by either activating the immune system directly, or by inhibiting mechanisms of suppression of the cancer.

In an attempt to improve the chance of cure, immunotherapies are being tested alone or in combination with chemotherapy in clinical trials.