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PD-1 inhibitors versus chemotherapy as second-line treatment for advanced esophageal squamous cell carcinoma: a

Xinxin Zhu1, Qiyue Shanzhou1, Danyang Li1

  • 1Department of Oncology, Affiliated Hospital of North Sichuan Medical college, No.1 Maoyuan South Road, Shunqing District, Nanchong, Sichuan, 637000, China.

BMC Cancer
|November 11, 2021
PubMed
Abstract

Insights

Second-line programmed cell death protein 1 (PD-1) inhibitors significantly improve overall survival and response rates in advanced esophageal squamous cell carcinoma (ESCC). These inhibitors offer a superior safety profile compared to chemotherapy for ESCC treatment.

Area of Science:

  • Oncology
  • Immunotherapy
  • Clinical Trials

Background:

  • Advanced esophageal squamous cell carcinoma (ESCC) presents a significant therapeutic challenge.
  • Programmed cell death protein 1 (PD-1) inhibitors have emerged as a promising treatment modality.

Purpose of the Study:

  • To evaluate the efficacy and safety of PD-1 inhibitors as second-line therapy for advanced ESCC.
  • To compare PD-1 inhibitors with conventional chemotherapy in this patient population.

Main Methods:

  • Systematic review and meta-analysis of published randomized controlled trials.
  • Searched PubMed, Medline, Embase, ASCO, and ESMO databases up to September 2021.
  • Synthesized data on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs).

Main Results:

  • Second-line PD-1 inhibitors significantly improved OS (HR=0.73) and ORR (RR=1.89) compared to chemotherapy in advanced ESCC.
  • OS was particularly prolonged in patients with positive programmed death-ligand 1 (PD-L1) expression (HR=0.64).
  • No significant improvement was observed in PFS (HR=0.88) or DCR (RR=0.89); however, PD-1 inhibitors showed a statistically lower incidence of grade 3-5 TRAEs.

Conclusions:

  • Second-line PD-1 inhibitors demonstrate significant survival and response benefits for advanced ESCC patients, especially those with PD-L1 expression.
  • PD-1 inhibitors offer a superior safety profile compared to chemotherapy in the second-line setting for advanced ESCC.
  • While PFS and DCR were not significantly improved, the overall survival gains and improved safety warrant consideration of PD-1 inhibitors.
Keywords:
ChemotherapyEfficacyEsophageal squamous cell carcinomaPD-1Safetymeta-analysis

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