Current landscape of immunotherapy in esophageal cancer: a literature review

Background and Objective: Esophageal cancer has witnessed a significant shift in its epidemiology within the United States. Adenocarcinoma of the esophagus is now the fastest-growing solid malignancy, surpassing esophageal squamous cell carcinoma (ESCC) in frequency. There has been a concentrated effort to establish new therapies for dealing with this malignancy including immunotherapy in conjunction with surgery and radiotherapy. Our objective is to provide a comprehensive review of the current therapeutic strategies for esophageal cancer, with a particular focus on the emerging role of immunotherapy in combination with surgery and radiotherapy, and its impact on treatment outcomes. Methods: A thorough search was done using keywords of "esophageal cancer", "immunotherapy in esophageal cancer", and "immunotherapy" in PubMed, MEDLINE, and Google Scholar databases. All studies that were identified in this search were analyzed for relevance and content. Key Content and Findings: A total of 1,555 studies were identified which were checked for relevance and content. Fifteen articles were reviewed which focused on esophageal cancer and the immunotherapy directed towards this condition. This review article summarizes the most recent and available evidence on immunotherapy directed towards the treatment of esophageal cancer. Conclusions: Esophageal cancer treatment is undergoing a paradigm shift with the advent of immunotherapy, particularly programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors. These therapies hold promise for both second-line and first-line settings, with evolving biomarkers guiding treatment decisions. Combination strategies and personalized approaches are actively investigated to overcome resistance mechanisms and enhance treatment outcomes in this challenging cancer type.