Optimizing care for patients receiving systemic treatment for gastroesophageal cancer

Advanced gastroesophageal cancer typically carries a grim prognosis, albeit with some potential improvement through systemic therapy.
This thesis discusses treatment for gastric and esophageal cancer, both curative and palliative. The first study included is a nationwide, population based cohort study that looks into incidence, stage, treatment and treatment outcomes in patients diagnosed with gastric cancer in the Netherlands. The second chapter reviews microsatellite instability as a predictive biomarker in patients treated for gastroesophageal cancer, and the third chapter explores circulation tumor DNA analysis as both a predictive and prognostic biomarker in this population. Chapter 4 is another population based cohort study and investigates the time to treatment failure on first-line palliative therapy in gastroesophageal cancer patients as a predictive factor for second-line treatment outcomes. Chapter 5 discusses chemotherapy induced peripheral neuropathy in gastroesophageal patients, a common side effect of patients treated with either curative or palliative intent.
For a great number of patients with gastroesophageal cancer, no predictive biomarkers are available and the extent of survival extension is often modest. Consequently, prioritizing the preservation of quality of life should stand as a primary objective in the overall treatment approach.