Endoscopic brush cytology and single cell clinal dynamics of early easophageal adenocarcinoma for detecting cost effective surveillance strategies and prediction of cancer recurrence

In many European countries the recent rise in incidence of esophageal adenocarcinoma (EAC) is without precedent. EAC is notorious for its highly aggressive biological behavior leading to invasive disease and early metastases. The only way to reduce mortality is through treatment in early stage of the cancer.

EAC has a well recognized premalignant precursor lesion identified as esophageal metaplasia, or Barrett’s Esophagus (BE), which offers important opportunities for treatment in early stages of cancer which may reach 5-years survival rates up to 80%.

However, these patients need to be monitored constantly for timely intervention in case of disease recurrence or metastases.

The problem is that after endoscopic treatment up to 30% of cases will develop recurring cancers or even present with metastases, which requires additional endoscopic treatments or surgery.

Currently it is impossible to predict which of the treated BE patients with will have stable disease and which will recur or progress to invasive cancer. As a consequence all treated patients need to remain in frequent endoscopic surveillance. This leads to over-treatment of a large group of BE patients and under-treatment of those with more aggressive disease.

There is a low cost effectiveness of endoscopic therapies, low quality of life of patients and poor satisfaction of care providers. An accurate risk stratification method for early AEC in BE patients is therefore an unmet clinical need.

The ambition of the ENDEAVOR consortium is to implement an innovative risk stratification method, which encompasses minimally invasive cell collection supplemented by single cell genomic analysis to address this specific need.

Taking into account patient characteristics, gender dimensions, an optimal model model will be tested in a randomized controlled prospective trial.

Future implementation of this method will reduce health care costs, increase quality of life and satisfaction of health care providers. This action is part of the Cancer Mission cluster of projects on Diagnostics and Treatment (diagnostics).