Cancer Res Treat.  2022 Apr;54(2):505-516. 10.4143/crt.2020.1198.

Real-World Efficacy Data and Predictive Clinical Parameters for Treatment Outcomes in Advanced Esophageal Squamous Cell Carcinoma Treated with Immune Checkpoint Inhibitors

• Kim JH
• Ahn B
• Hong SM
• Jung HY
• Kim DH
• Choi KD
• Ahn JY
• Lee JH
• Na HK
• Kim JH
• Kim YH
• Kim HR
• Lee HJ
• Kim SB
• Park SR

• KMID: 2528220
• DOI: http://doi.org/10.4143/crt.2020.1198

Abstract

Purpose
This study aimed to evaluate the real-world efficacy of immune checkpoint inhibitors (ICIs), and to identify clinicolaboratory factors to predict treatment outcomes in patients with advanced esophageal squamous cell carcinoma (ESCC) receiving ICIs.
Materials and Methods
Sixty patients with metastatic or unresectable ESCC treated with nivolumab (n=48) or pembrolizumab (n=12) as ≥ second-line treatment between 2016 and 2019 at Asan Medical Center were included.
Results
The median age of the patients was 68 years (range, 52 to 76 years), and 93.3% were male. Most patients had metastatic disease (81.7%) and had been previously treated with fluoropyrimidines, platinum, and taxane. In 53 patients with measurable disease, the overall response rate and disease control rate were 15.1% and 35.8%, respectively. With a median follow-up duration of 16.0 months, the median progression-free survival (PFS) and overall survival (OS) were 1.9 months (95% confidence interval [CI], 1.54 to 2.19) and 6.4 months (95% CI, 4.77 to 8.11), respectively. After multivariate analysis, recent use of antibiotics, low prognostic nutrition index (< 35.93), high Glasgow Prognosis Score (≥ 1) at baseline, and ≥ 1.4-fold increase in neutrophil-to-lymphocyte ratio after one cycle from baseline were significantly unfavorable factors for both PFS and OS. Younger age (< 65 years) was a significant factor for unfavorable PFS and hyponatremia (< 135 mmol/L) for unfavorable OS.
Conclusion
The use of ICIs after the failure of chemotherapy showed comparable efficacy in patients with advanced ESCC in real practice; this may be associated with host immune-nutritional status, which could be predicted by clinical and routine laboratory factors.

Keyword

Esophageal squamous cell carcinoma; Pembrolizumab; Nivolumab; Survival

Figure

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  Fig. 1 Representative images of two patients who achieved complete response (CR) with immune check point inhibitors. (A) Esophagogastroduodenoscopy and endoscopic ultrasound images of a 71-year-old man with recurrent localized unresectable esophageal squamous cell carcinoma after chemoradiotherapy who was treated with pembrolizumab. After completion of 2-year pembrolizumab treatment, endoscopically CR with no residual cancer cells on biopsy was confirmed. (B) Computed tomography scans of 61-year-old man with recurrent metastatic esophageal squamous cell carcinoma who was treated with nivolumab. After 6 cycles of nivolumab treatment, metastatic lymph nodes and lung nodules disappeared.

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  Fig. 2 The Kaplan-Meier curves of progression-free survival (A) and overall survival (B). CI, confidence interval.

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  Fig. 3 (A-L) The Kaplan-Meier curves of progression-free survival and overall survival according to significant clinicolaboratory factors. GPS, Glasgow Prognosis Score; PNI, prognostic nutrition index.

Reference

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