Successful Combination Immunotherapy for Postoperative Recurrence of Esophageal Cancer Following Prior Immune...

Esophageal squamous cell carcinoma (ESCC) remains an extremely aggressive malignancy with a poor prognosis, particularly among patients with distant metastases. Although systemic chemotherapy is the standard of care for patients with stage IV disease, conversion surgery has emerged as a promising treatment strategy for selected patients who respond favorably to systemic therapy. The introduction of immune checkpoint inhibitors (ICIs) has increased the therapeutic opportunities. However, the optimal management of postoperative recurrence after ICI-based conversion surgery remains unclear. Here, we report a case of postoperative recurrent ESCC after ICI-based conversion surgery in which long-term disease control was achieved through sequential multidisciplinary treatment, including chemoradiotherapy and subsequent dual immune checkpoint blockade.

A 68-year-old woman was diagnosed with stage IVB ESCC (cT3N2M1b) with para-aortic lymph node metastasis. The patient received 3 cycles of pembrolizumab combined with cisplatin and 5-fluorouracil (FP), which resulted in marked tumor regression. She underwent robot-assisted thoracoscopic subtotal esophagectomy with para-aortic lymphadenectomy; an R0 resection was achieved. The pathological diagnosis was squamous cell carcinoma with grade 2b tumor regression. Postoperative adjuvant therapy with nivolumab was initiated. Five months after surgery, locoregional recurrence occurred, and the patient was treated with chemoradiotherapy using docetaxel, followed by combination immunotherapy with nivolumab and ipilimumab. Remarkable regression of the recurrent lesions was achieved, and the patient has remained disease-controlled for 22 months postoperatively without further treatment.

Dual immune checkpoint blockade with nivolumab and ipilimumab may represent a potential therapeutic option for patients with recurrent ESCC following ICI treatment. This case underscores the importance of individualized treatment strategies and the evolving role of immunotherapy in the multidisciplinary management of patients with advanced esophageal cancer.