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Case report
Role of oesophageal balloon cryoablation in combination with personalised immunotherapy to achieve luminal control in metastatic oesophageal cancer: a case report
  1. Benjamin Charles Norton1,2,
  2. Apostolis Papaefthymiou1,
  3. Andrea Telese1,3,
  4. Margaret Duku1,
  5. Imran Chaudhry4,
  6. Alberto Murino1,
  7. Gavin Johnson1,
  8. Charles Murray1,
  9. Rehan Haidry1
  1. 1 Digestive Disease & Surgery Institute, Cleveland Clinic London, London, UK
  2. 2 Centre for Obesity Research, University College London, London, UK
  3. 3 Division of Surgery and Interventional Science, University College London, London, UK
  4. 4 Cleveland Clinic London, London, UK
  1. Correspondence to Dr Benjamin Charles Norton, Digestive disease & surgery institute, Cleveland Clinic London, London, UK; benjamin.norton{at}nhs.net

Abstract

Metastatic oesophageal adenocarcinoma (OAC) is associated with a poor prognosis, but patients with a good performance status may be offered palliative oncological intervention. Oesophageal cryoablation is an emerging therapy for the palliation of malignant dysphagia that can be given over multiple sessions with relatively few side effects. Emerging evidence suggests that cryoablation may provide a synergistic effect with modern immunotherapies as cryonecrosis leads to the release of many tumour-specific autoantigens that induce a systemic antitumour response. We present the case of a 39-year-old man who presented with several months of non-specific upper abdominal pain and heartburn. He was subsequently diagnosed with metastatic OAC and proceeded to self-funded genomic tumour profiling. This enabled initiation of a personalised oncological treatment plan involving immunotherapy and a neoantigen cancer vaccination regimen. To facilitate continued oral intake and avoid the risk of endoscopic stenting, the patient underwent a concurrent programme of oesophageal balloon cryoablation over eight sessions. At 15 months following his diagnosis, he had complete histological remission of luminal disease and a preserved systemic treatment response. In summary, oesophageal cryoablation is an endoscopic option for luminal control among patients undergoing immunotherapy for metastatic OAC. This would provide a synergistic treatment effect and mitigate against the risk of endoscopic stenting.

  • OESOPHAGEAL CANCER
  • ENDOSCOPY
  • IMMUNOTHERAPY

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Footnotes

  • Contributors Conceptualisation: BCN, RH and IC. Methodology: BCN. Data curation: BCN, IC, AP, AT and MD. Writing—original draft preparation: BCN. Writing—review and editing: BCN, AP, AT, IC, CM, AM, GJ, MD and RH. All authors have read and agreed to the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RH declares educational grants to support research infrastructure from Cook medical, Odin Vision, Pentax medical, Endogastric Solutions, Apollo Endosurgery, Medtronic, and Aqua Medical. The remaining authors declare no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.