| Although outcomes for patients with gastroesophageal cancer has improved in recent times, the average survival for most patients in Europe is less than one year. Drug development in gastroesophageal cancer has had limited success compared to other diseases; only trastuzumab, ramucirumab and lately anti-PD-1 therapies have been useful in prolonging survival but there is a marked lack of other novel therapies. Reasons for this include patient related factors such as late diagnosis and disease related morbidity and disease specific factors such as inter- and intra-patient heterogeneity of biomarker expression. Work from groups such as the TCGA, ICGC and OCCAMs provide valuable insights into the underlying biology of gastroesophageal cancer which must now be used to inform clinical trials. The next generation of clinical trials should consider different approaches to trial design in order to optimise use of resources and to better select the correct population of patients to benefit from emerging drugs. Variance in outcomes in Asian and non-Asian patients introduce another layer of complexity in international trials, but international collaboration remains essential for global drug development. The aim of this lecture is to explore the past, present and future of drug development in gastroesophageal cancer with a view to considering how we might improve survival for patients with this disease. |
