Neoadjuvant chemoimmunotherapy beneficial in locally advanced ESCC

In the treatment of locally advanced esophageal squamous cell carcinoma (ESCC), neoadjuvant chemoimmunotherapy may prolong overall and disease-free survival compared with neoadjuvant chemoradiotherapy, according to a study from China.

The study included 1,428 patients (median age 63 years, 82.9 percent male) with locally advanced ESCC who underwent esophagectomy following neoadjuvant chemoradiotherapy (n=704) or chemoimmunotherapy (n=724).

Two-year overall survival (OS) and disease-free survival (DFS) were assessed as primary endpoints. Other endpoints such as major pathologic response (MPR) and pathologic complete response (pCR) were considered secondary. Cox proportional hazard regression models were used in the analysis.

Propensity-score matching was applied, leaving 532 patients in each group. Compared with neoadjuvant chemoradiotherapy, neoadjuvant chemoimmunotherapy was associated with better 2-year OS (81.3 percent vs 71.3 percent; hazard ratio [HR], 1.57, 95 percent confidence interval [CI], 1.26–1.96; p<0.001) and DFS (73.9 percent vs 63.4 percent; HR, 1.37, 95 percent CI, 1.11–1.69; p<0.001).

The MPR rates were higher in the chemoradiotherapy vs the chemoimmunotherapy group (71.8 percent vs 61.5 percent), whereas the pCR rates were similar (25.9 percent vs 22.9 percent).

Neoadjuvant chemoimmunotherapy and MPR independently correlated with OS and DFS.

Patients who received neoadjuvant chemoimmunotherapy vs chemoradiotherapy had a lower overall recurrence rate (23.7 percent vs 35.7 percent) and distant metastasis rate (13.5 percent vs 25.0 percent). No significant between-group difference was seen in locoregional metastasis rates (18.4 percent vs 20.9 percent).

Finally, OS and DFS were more favourable in the neoadjuvant chemoimmunotherapy group, regardless of whether adjuvant immunotherapy was given.