A case study of combined neoadjuvant chemotherapy and neoadjuvant immunotherapy in resectable locally advanced esophageal cancer

Abstract

Background The prognosis of patients under existing neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy requires improvement. Whereas programmed cell death 1 (PD-1) inhibitors have shown promising response in advanced esophageal cancer, they have not been used in the perioperative treatment of resectable locally advanced esophageal cancer. Whether immunotherapy can be incorporated into neoadjuvant therapy has became a challenging question for researchers. Case presentation We present a case of a 65-year-old male who had a history of progressive dysphagia for approximately 1 month. He underwent pertinent studies including computed tomography (CT)，gastroscopy，and pathological biopsy resulting in a diagnosis of medium-low differentiated squamous carcinoma of the thoracic segment of the esophagus (cT2N2M0 stage III). After 4 cycles of neoadjuvant chemotherapy combined with immunotherapy, gastroscopy showed the lesion in the esophagus was no longer present. Subsequently, the patient received thoracoscopic radical resection of esophageal cancer and achieved a pathological complete response (pCR) in postoperative pathological evaluation. During the whole treatment, no adverse effect was recorded and to date no evidence of recurrence has been recorded. Conclusion Our report suggest that neoadjuvant chemotherapy combined with immunotherapy not only improve the R0 resection and pCR rate in patients with resectable locally advanced esophageal cancer, but also the adverse effects are within the control range. However, the selection of therapeutic strategy, predictors of response to treatment, and interval time between neoadjuvant treatment and surgery still await more reliable evidence-based studies with large prospective samples.

Laparoscopic versus open pancreatoduodenectomy following neoadjuvant chemotherapy for borderline resectable pancreatic ductal adenocarcinoma: protocol of a multicenter, open-label randomized clinical trial (CSPAC-5)

“…By retrospectively analyzing clinical data from patients with borderline resectable PDAC who underwent NACT followed by LPD or OPD (20 cases vs 57 cases) at Fudan University Shanghai Cancer Center between January 2020 and December 2022, we found that despite a longer median operative time (419 vs. 325 min, P < 0.001), the LPD group had a signi cantly lower Clavien-Dindo complication rate (35.0% vs 66.7%, P = 0.018). There were no signi cant differences between the two groups in the number of retrieved lymph nodes, R1 resection rate, median postoperative length of stay, recurrence-free survival (RFS), and OS [20]. All 20 patients in the LPD group underwent successful operations without conversion to open surgery.…”

“…The sample size is calculated based on the Clavien-Dindo complication rate. According to the retrospective study experience of our center, the incidence of Clavien-Dindo complications of open pancreaticoduodenectomy is 66.7%, and that of laparoscopic pancreaticoduodenectomy is 35.0% [20]. The sample size was calculated using the Tests for Two Proportions module of software PASS 2015 (NCSS, LLC, 329 North 1000 East Kaysville, Utah 84037).…”

“…Nevertheless, the safety and e cacy of LPD compared with OPD after NACT for borderline resectable PDAC have rarely been reported [19]. We retrospectively analyzed clinical data from patients with borderline resectable PDAC who underwent LPD (20 cases) or OPD (57 cases) after NACT at Fudan University Shanghai Cancer Center from January 2020 to December 2022 and demonstrated that LPD in such patients had lower postoperative complications and the same oncological safety compared with OPD [20]. But the result was limited by the small sample of the single-center study and the nature of retrospective studies.…”