Efficacy and safety of neoadjuvant chemotherapy and immunotherapy in locally resectable advanced esophageal squamous cell carcinoma

Abstract

Background: Esophageal squamous cell cancer (ESCC) patients with the potentially resectable disease most would experience relapse after surgery. Immunotherapy has been reported to improve the prognosis of advanced esophageal cancer and may be a new strategy to prevent this urgent condition's recurrence. We first evaluated the efficacy and safety of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable ESCC.Methods: All patients with resectable locally advanced ESCC (clinical stage III-IVB). Received at least 1 cycle of neoadjuvant chemotherapy combined with immunotherapy (NACI), and the interval between each cycle and the operation should be at least 3 weeks. All patients were treated with standard surgery. The tumor imaginations were obtained at baseline and within a week before surgery. The efficacy endpoint was the rate of major pathologic response (MPR, 10% viable tumor cells). Expression of immunohistochemicalrelated molecules was investigated in surgical samples. Results: A total of 38 patients with ESCC were included (36 males, median age 61 years), and most of them used Pembrolizumab (55.26%) and Camrelizumab (31.58%). We analyzed 19 patients and found that 13 patients (68.42%) achieved radiological partial response (PR) by CT images. R0 resection was performed in 35 patients (92.11%), and 10 patients (26.32%) developed postoperative complications. Through postoperative pathology, we found 13 (34.21%) patients had complete pathologic response (cPR), and 16 (42.11%) patients achieved MPR. We also found that none of the factors had a statistically significant impact on MPR. Still, the regression rate of Sum of lesion diameter (SLD) was significantly positively correlated with the pathological remission rate (P=0.012, r=0.565). Conclusions: The rate of MPR in ESCC patients reached 42.11%. The use of the NACI regimen did not increase the occurrence of complications in neoadjuvant treatment and operation, and the SLD regression rate has a certain guiding significance for the effect of immunotherapy.

Neoadjuvant camrelizumab plus chemotherapy in treating locally advanced esophageal squamous cell carcinoma patients: a pilot study

“…Regarding pathological response, previous studies exhibited that an R0 resection rate was 96.3% and a pCR rate was 33.3% in patients with locally advanced ESCC receiving neoadjuvant nivolumab and pembrolizumab plus chemotherapy [ 9 ]. Likewise, in another study, pCR rate was 34.21%; meanwhile, R0 resection rate was 92.11% in locally advanced ESCC patients receiving neoadjuvant camrelizumab and pembrolizumab plus chemotherapy [ 25 ]. In this present study, 5 (31.3%), 6 (37.5%), 3 (18.8%), and 2 (12.5%) patients reached TRG 0, TRG 1, TRG 2, and TRG 3, respectively; 31.3% patients had pCR; meanwhile, 93.8% patients were witnessed with R0 resection.…”

The Safety and Efficacy of Neoadjuvant Camrelizumab Plus Chemotherapy in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma: A Retrospective Study

“…[10][11][12] Moreover, anti-PD-1 agents combined with chemotherapy or chemoradiation was recently explored for neoadjuvant therapy in locally advanced ESCC, which exhibited an acceptable therapeutic response and a low-toxicity profile. [13][14][15][16] Park et al reported that neoadjuvant pembrolizumab plus platinum-based chemoradiotherapy may not increase the operative risk or reduce the quality of radical dissection including lymphadenectomy. 17 The Phase 3 ESCORT study undertaken in China showed that camrelizumab, a novel IgG4-kappa PD-1 inhibitor, significantly improved overall survival of patients with advanced or metastatic ESCC compared with chemotherapy.…”

Efficacy and safety of camrelizumab (a PD‑1 inhibitor) combined with chemotherapy as a neoadjuvant regimen in patients with locally advanced non‑small cell lung cancer

“…Furthermore, camrelizumab plus anlotinib achieved a median PFS time of 8.2 months and a median OS time of 12.7 months in patients with advanced NSCLC who had been subjected to multiple failed lines of treatment ( 17 ). However, the use of camrelizumab as a neoadjuvant therapy in cancer lacks sufficient evidence, and only a limited number of reports have been published, including two studies on neoadjuvant camrelizumab plus chemotherapy with or without apatinib in locally advanced esophageal squamous cell carcinoma and gastroesophageal junction adenocarcinoma ( 28 , 29 ), and one study on neoadjuvant camrelizumab plus lenvatinib in patients with hepatocellular carcinoma (HCC) who underwent a liver transplant ( 30 ). In detail, neoadjuvant camrelizumab plus nab-paclitaxel and S1 achieved a 33% CPR and 75% MPR in locally advanced esophageal squamous cell carcinoma ( 28 ), while another study reported the use of neoadjuvant immunotherapy involving camrelizumab plus chemotherapy, realizing a 34% CPR and 76% MPR in locally advanced esophageal squamous cell carcinoma and gastroesophageal junction adenocarcinoma ( 29 ).…”