Is Genetic Testing Required for Targeted Therapy in Esophageal Cancer?

Esophageal cancer is a complex disease, and the approach to targeted therapy depends heavily on the specific pathology type and the selected treatment options. There are two primary subtypes of esophageal cancer: squamous cell carcinoma and adenocarcinoma. For patients diagnosed with esophageal adenocarcinoma, genetic testing is considered a crucial step before initiating targeted therapy. In particular, testing for HER2 gene mutations is recommended, as patients who test positive may benefit from anti-HER2 targeted therapy combined with chemotherapy. This combination has shown to significantly improve survival outcomes in clinical studies.

On the other hand, patients with esophageal squamous cell carcinoma typically do not require genetic testing before receiving certain targeted therapies. For example, drugs such as apatinib and anlotinib, which are multi-target tyrosine kinase inhibitors that primarily work by inhibiting tumor angiogenesis, are approved for use in later lines of treatment. These medications do not require prior genetic profiling and have demonstrated clinical benefits in extending survival.

Currently, the number of FDA-approved targeted therapies for esophageal cancer remains limited. As a result, many of the available treatment options do not rely on genetic testing to determine eligibility. However, ongoing research and clinical trials continue to explore new biomarkers and targeted agents that may expand the role of precision medicine in the future. Decisions regarding genetic testing should be made in consultation with a multidisciplinary team to ensure the most appropriate and personalized treatment plan.