Complete remission in metastatic esophageal carcinoma during symptom directed ayurvedic management: A case report

Abstract

Metastatic esophageal squamous cell carcinoma (ESCC) has a poor prognosis. This report documents an observed complete metabolic response (CMR) in a patient with relapsed-refractory esophageal carcinoma (EC) during concurrent Ayurvedic symptom management. A 56-year-old nonalcoholic, smoker male with tuberculosis of the ileocecal valve receiving anti-tubercular treatment developed dysphagia and vomiting and was diagnosed with ESCC. He received 5 days of esophageal radiation therapy (RT) and capecitabine for 21 days. Positron Emission Tomography-Computed Tomography (PET-CT) on January 20, 2022, performed for response assessment, showed progressive metabolic disease (PMD) with new hepatic and skeletal lesions and lymphadenopathy. He then received six cycles of a taxane-platinum and PET-CT on August 26, 2022 showed partial metabolic response (PMR). He received nivolumab after PET-CT (November 28, 2022) showed PMD. After four cycles of nivolumab, scans showed PMR (PET-CT on February 20, 2023) and PMD (PET-CT on May 12, 2023) after eight cycles. He then received two fractions of intraluminal RT and four cycles of irinotecan and showed PMR (PET-CT on September 26, 2023). During the period of irinotecan, he attended Ayurveda outpatient department for symptom palliation. Irinotecan was discontinued due to the patient’s poor tolerance and reluctance to continue chemotherapy. Remarkably, sequential PET-CT scans on December 11, 2023 and April 12, 2024 showed PMR and CMR, respectively. This report does not correlate the CMR with Ayurveda management. The delayed CMR may reflect delayed immunotherapy or radiation effects or cumulative effects of prior treatment or other factors. This temporal association warrants hypothesis generation and further investigation of integrative supportive care.