Overview of Standard of Care and Testing Approaches in Advanced ESCC

This discussion provides an in-depth overview of the current standard of care for advanced esophageal squamous cell carcinoma (ESCC), with brief parallels to biomarker-driven gastric cancer management. Chemotherapy, most commonly fluoropyrimidine-based regimens combined with a platinum agent such as oxaliplatin or cisplatin, remains the treatment foundation, consistent with NCCN-endorsed approaches. The segment highlights the growing importance of molecular profiling, emphasizing next-generation sequencing (NGS) and immunohistochemistry for key biomarkers. In ESCC and related esophagogastric tumors, PD-L1 and mismatch repair/microsatellite instability status are central to immunotherapy decision-making, while in gastric and GEJ adenocarcinoma HER2 and claudin 18.2 have become critical targets. Experts underscore that timely biomarker testing, ideally completed before treatment initiation, guides selection of chemotherapy backbones, immunotherapy, and targeted agents, as contemporary guidelines increasingly advocate early, comprehensive evaluation. There is also mention of nuances in PD-L1 scoring (CPS vs TAP) and the need for standardized reporting across laboratories. This segment offers a practical framework for integrating testing into advanced ESCC care, with scalable lessons for gastric cancer.