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Comparison of PD-1 Inhibitors in Patients With Advanced Esophageal Squamous Cell Carcinoma in the Second-Line Setting

Yi-Xin Zhou1, Ping Chen1, Yu-Ting Sun2

  • 1Department of VIP Region, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.

Frontiers in Oncology
|October 8, 2021
PubMed
Abstract

Insights

This study compared programmed death 1 (PD-1) inhibitors for esophageal squamous cell carcinoma (ESCC). Nivolumab showed a survival benefit for patients with performance status 1, while pembrolizumab and camrelizumab offered higher efficacy for others.

Area of Science:

  • Oncology
  • Immunotherapy
  • Clinical Trials

Background:

  • The KEYNOTE-181, ATTRACTION-3, and ESCORT trials established programmed death 1 (PD-1) inhibitors for second-line therapy in esophageal squamous cell carcinoma (ESCC).
  • No direct head-to-head comparisons exist for pembrolizumab, nivolumab, and camrelizumab in the second-line ESCC setting.
  • This study provides an indirect comparison to guide the optimal choice of immune checkpoint inhibitors (ICIs) for advanced ESCC.

Purpose of the Study:

  • To indirectly compare the efficacy and safety of pembrolizumab, nivolumab, and camrelizumab in the second-line treatment of advanced esophageal squamous cell carcinoma (ESCC).
  • To identify the optimal immune checkpoint inhibitor (ICI) based on patient characteristics and desired outcomes.

Main Methods:

  • An indirect comparison was performed using data from the KEYNOTE-181, ATTRACTION-3, and ESCORT trials.
  • Only data from squamous carcinoma patients in KEYNOTE-181 were included, along with all patients from ATTRACTION-3 and ESCORT.
  • Key outcomes assessed included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (TRAEs).

Main Results:

  • All three PD-1 inhibitors demonstrated similar survival benefits.
  • Nivolumab showed a slight advantage over pembrolizumab for patients with a performance status (PS) score of 1.
  • Pembrolizumab and camrelizumab showed improved PFS and significantly higher ORR compared to nivolumab, though camrelizumab was associated with a higher rate of TRAEs.

Conclusions:

  • Nivolumab is recommended for ESCC patients with PS score of 1.
  • Pembrolizumab or camrelizumab are recommended for patients with better PS, seeking higher efficacy or longer PFS.
  • The choice of ICI should consider patient PS and desired treatment outcomes, balancing efficacy with safety profiles.
Keywords:
PD-1 inhibitorcamrelizumabesophageal squamous cell carcinomanivolumabpembrolizumabsecond line therapy

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