Treating UGI with subcutaneous immunotherapy

Upper gastrointestinal tract (UGI) cancer refers to cancers that affect the upper part of the gastrointestinal tract. This includes cancers of the esophagus, stomach, and small intestine cancer (the part of the intestine just below the stomach). UGI cancers also include cancers in the gastroesophageal junction (the part of the GI tract that connects the esophagus to the stomach) and the duodenum (the part of the small intestine that connects to the stomach).

Cancers of the pancreas, liver, and other nearby organs are also sometimes categorized as UGI cancers. These organs can also be affected by stomach cancer that extends through the stomach wall and spreads.

Here, we will be focusing mostly on cancers of the esophagus and stomach.

Treatment for esophageal and stomach cancers

As with any type of cancer, treatment for esophageal and stomach cancers will depend on multiple factors about the cancer and the person being treated:

• The type of cancer, including the location and the type of cells where the cancer began
• The stage of the cancer, including the size of the tumor, if the cancer has spread, and where the cancer has spread
• The results of lab tests that look at the cancer’s biomarkers, such as gene mutations, proteins, and hormones the cancer is using to grow and spread
• A person’s age, overall health (including any coexisting health conditions), and preferences about treatment

Treatment for esophageal and stomach cancers can include surgery, radiation therapy, and systemic therapies (anti-cancer drugs), such as chemotherapy, targeted therapy, and immunotherapy. A treatment plan will often include a combination of different therapies.

What is immunotherapy?

The body’s immune system has natural defenses against cancerous cells. Cancers occur when cancerous cells can evade detection by the immune system, weaken the immune system, or grow too quickly for the immune system to keep up.

Immunotherapy is a category of cancer treatments that help the immune system fight cancer. The immunotherapies used for the treatment of esophageal and stomach cancers are immune checkpoint inhibitors.

These drugs work by disabling or blocking immune checkpoints, proteins that prevent the body’s immune system from attacking healthy cells. Some cancer cells use immune checkpoints to avoid being detected by the immune system. Immune checkpoint inhibitors block or disable immune checkpoints, which helps the immune system detect and attack cancer cells.

These medications will often be prescribed in combination with other therapies. For example, it may be prescribed after surgery or radiation therapy, or used in combination with chemotherapy.

In some cases, a healthcare provider may prescribe a checkpoint inhibitor that is administered with subcutaneous injections.

What is a subcutaneous injection?

Subcutaneous refers to the location of the body where the drug is administered—the subcutaneous layer, a layer of fatty tissue just beneath the skin. These injections are typically given in the abdomen or thigh. This is different from an intravenous (IV) infusion, which is administered into a vein. Studies show that subcutaneous immunotherapy drugs are as effective as intravenous infusions of a drug.

Why might your healthcare team recommend subcutaneous immunotherapy?

Subcutaneous injections may make treatment more accessible or make this step in treatment an easier process for the person with cancer.

• A subcutaneous injection can be administered at a healthcare provider’s office, and does not require a visit to a hospital or an infusion clinic—which can be helpful if getting to a hospital or infusion clinic is difficult or time consuming.
• Subcutaneous injections also take between 3 and 5 minutes to administer, a much shorter time than IV infusions, which can take between 30 and 90 minutes.

As with any cancer treatment, subcutaneous immunotherapies will be a good treatment option for some people, while other treatment options will be recommended for other people. If you have questions about treatment options, your healthcare provider will be your best source of information.